As a member of CarePlus, this page is just for you. Here you can find the information and forms you need to help manage your healthcare decisions and provide us with feedback.
We want to make it easier for you to help stay in control of your healthcare. As one of our 90,000* members, you are the reason why we work hard to provide you with improved benefits, value and convenience each year. We have always believed that good health care starts with taking good care of your health. That's why we focus on prevention and giving you the benefits you need to stay healthier and happier.
*The Centers for Medicare & Medicaid Services (CMS) Medicare Advantage (MA) Membership Reports July 2014
The Overall Star Rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance. The information provided below is an overall star rating for CarePlus’ performance. In addition, you can visit www.medicare.gov to see detailed ratings and find out more about the differences between plans.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
CarePlus wants to keep you informed. The Today newsletter is mailed twice a year to CarePlus members and includes helpful information like recipes, educational and health-related articles and company updates.
Today newsletter is published twice a year for CarePlus members. The articles in this publication are primarily for educational purposes, and should not be considered specific medical advice. Should any beneficiary feel the need for medical advice, please consult your primary care physician for specific health concerns.
You or your authorized representative may file a grievance request either orally or in writing. For important information on how to file a grievance, please click one of the options below.
For important information and forms about Coverage Determinations, Redeterminations and how to appoint a representative, please click here.
To file a grievance or appeal, you can contact CarePlus in one of these ways:
Fax number: 1-800-956-4288
You can also file a complaint on CMS' website
You can also find detailed information in Chapter 9 of the CarePlus Evidence of Coverage (EOC) with regard to grievances, coverage determinations (including exceptions), and the appeals process. Links to the EOC can be found on our page entitled 2014 CarePlus Medicare Advantage Plan Information.
You can submit requests for payment reimbursement, along with proof of payment and a copy of the medial record documentation, if available with your request. To make sure you are giving us all the information we need to make a decision, you can either download a copy of the below Reimbursement Request Form or call Member Services and request the form. The Reimbursement Request Form or signed reimbursement request must be sent in writing.
Mail your request for payment together with any bills, receipts, and/or medical record documentation to us at the address mentioned below:
CarePlus Health Plans, Inc.
11430 NW 20th Street, Suite 300
Doral, FL 33172
Attention: Member Services department
Please note that if your documentation is not in English, you need to provide us with an accurate translation of the documents. Translation services will not be provided by CarePlus.
You can also find detailed information in CarePlus' Evidence of Coverage, under Chapter 7. Section 2.1.
If you are enrolled in a plan that offers OTC benefits, you can take advantage of a monthly allowance amount that you can use to order over-the-counter products. This includes things like cough medicine, pain relievers and first aid items. These products can be sent directly to your home through our easy-to-use OTC mail-order service.
From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.
Call CarePlus at 1-800-794-5907; from 8 a.m. to 8 p.m., 7 days a week. From February 15th to September 30th, we are open Monday – Friday from 8 a.m. to 8 p.m. TTY users should call 711.