Overpayment Recovery Form Please mail this form and any other required documentation to CareSource at the address below. CARESOURCE Attention: Claim Recovery Department P.O. Box 632128 Cincinnati, OH 45263-2128 Completion of this form in its entirety is required in order to assist with accurate and timely reprocessing of your claims. Include any required documentation with your submission. D o not use this form for the following: Submi ssion of Appeals or CorrespondenceSending payment Claim Number Member ID Date of Service Amount of Overpayment Claim Paid Amount Reason for Refund 123456789XX00 1234567890 00/00/0000 $50000.00 $50000.00 Coordination of Benefits Provider Information Provider Name Provider Tax ID Provider NPI Remittance Address Service Address Alternate Remit Address (if different than Provider Remit) Contact Name Contact Phone NV-EXC-P-4262098
Notice Date: January 7, 2026 To: CareSource Ohio Medicaid Providers From: CareSource Subject: January 7, 2026 Policy Updates Effective Date: February 7, 2026 Summary At CareSource, we listen to our providers, and we streamline our business practices to make it easier for you to work with us. We have worked to create a predictable cycle for releasing administrative, medical, and reimbursement policies, so you know what to expect. Check back each month for a consolidated network notification of policy updates from CareSource. How to Use This Network Notification Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage with the full policy. Find Our Policies Online To access all CareSource policies, visit CareSource.com > Providers > Tools & Resources > Provider Policies. Select your plan and state, then the type of policy. Each revised policy has a previous version that can be referenced on the corresponding archived policy webpage. Policies Policy Name & Number Policy Type Plans Effective Date New or RevisionPolicy Medical Interventions for Gender Dysphoria MM-0034 MEDICAL OHIO MEDICAID FEBRUARY 7, 2026 REVISION OH-MED-P- 4959750
MEDICAL POLICY STATEMENT Ohio Medicaid Policy Name & Number Date Effective Medical Interventions for Gender Dysphoria-OH MCD-MM-0034 Policy Type MEDICAL Medical Policy Statement prepared by CareSource and its affiliates are derived from literature based on and supported by clinical guidelines, nationally recognized utilization and technology assessment guidelines, other medical management industry standards, and published MCO clinical policy guidelines. Medically necessary services include, but are not limited to, those health care services or supplies that are proper and necessary for the diagnosis or treatment of disease, illness, or injury and without which the patient can be expected to suffer prolonged, increased or new morbidity, impairment of function, dysfunction of a body organ or part, or significant pain and discomfort. These services meet the standards of good medical practice in the local area, are the lowest cost alternative, and are not provided mainly for the convenience of the member or provider. Medically necessary services also include those services defined in any Evidence of Coverage documents, Medical Policy Statements, Provider Manuals, Member Handbooks, and/or other policies and procedures. Medical Policy Statements prepared by CareSource and its affiliates do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Medical Policy Statement. If there is a conflict between the Medical Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determination. According to the rules of Mental Health Parity Addiction Equity Act (MHPAEA), coverage for the diagnosis and treatment of a behavioral health disorder will not be subject to any limitations that are less favorable than the limitations that apply to medical conditions as covered under this policy. Table of Contents A. Subject …………………………………………………………………………………………………………….. 2 B. Background………………………………………………………………………………………………………. 2 C. Definitions ………………………………………………………………………………………………………… 2 D. Policy ………………………………………………………………………………………………………………. 3 E. Conditions Of Coverage ……………………………………………………………………………………… 4 F. Related Policies/Rules ……………………………………………………………………………………….. 4 G. Review/Revision History …………………………………………………………………………………….. 4 H. References ………………………………………………………………………………………………………. 4 02/07/2026 The MEDICAL Policy Statement detailed above has received due consideration as defined in the MEDICAL Policy Statement Policy and is approved. 2 Medical Interventions for Gender Dysphoria-OH MCD-MM-0034 Effective Date: 02/07/2026A.SubjectMedical Interventions for Gender DysphoriaB.BackgroundState Medicaid programs have a responsibility to ensure that payments are consistent with efficiency, economy, and quality of care under Section 1902(a)(30)(A) of the Social Security Act. Section 1902(a)(19) requires that states provide such safeguards as may be necessary to ensure that covered care and services are provided in a manner consistent with the best interests of recipients. Agencies have a basic obligation to ensure the quality of Medicaid-covered care and that such care is provided in a manner consistent with the best interest of beneficiaries.Federal matching funds may not be claimed for any sterilization procedure performed on an individual under age 21, 42 C.F.R 441.253(a). Specifically, federal financial participation is unavailable for any procedure, treatment or operation done for the purpose of permanently rendering an individual incapable of reproducing, 42 C.F.R. 441.251. Additionally, 42 C.F.R. 441.255(a) prohibits financial federal participation for any hysterectomy performed solely for sterilization. All sterilization procedures must also meet the consent and waiting-period requirements set forth in 42 C.F.R. 441.252.254.C.Definitions Cross-Sex Hormone Testosterone, estrogen, or progesterone given to a minor individual in an amount greater than would normally be produced endogenously in a healthy individual of the minor individual’s age and sex. Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program A comprehensive preventive health program for individuals under age 21 that requires coverage of any service necessary to correct or ameliorate defects, physical and mental illnesses and conditions discovered by screening. 42 C.F.R. 441.50 et seq. Gender Dysphoria Affective and/or cognitive discontent accompanying incongruence between experienced or expressed gender and assigned gender, lasting at least 6 months and meeting diagnostic criteria listed in the DSM-5-TR. Gender Reassignment Surgery Any surgery performed for the purpose of assisting an individual with gender transition that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual’s biological sex, in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual’s birth sex, including genital or non-genital gender reassignment surgery. Gender-Related Condition Any condition where an individual feels an incongruence between the individual’s gender identity and biological sex, including gender dysphoria. Gender Transition Services Any medical or surgical service (including physician services, inpatient and outpatient hospital services, or prescription drugs or hormones) provided for the purpose of assisting an individual with gender transition The MEDICAL Policy Statement detailed above has received due consideration as defined in the MEDICAL Policy Statement Policy and is approved. 3 that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individuals biological sex, or to instill or create physiological or anatomical characteristics that resemble a sex different from the individuals birth sex, including medical services that provide puberty blocking drugs, cross-sex hormones, or other mechanisms to promote the development of feminizing or masculinizing features in the opposite sex, or genital or non-genital gender reassignment surgery. Minor Any member under the age of 18. Puberty-Blocking Drugs Gonadotropin-releasing hormone analogs or other synthetic drugs used to stop luteinizing hormone and follicle stimulating hormone secretion, synthetic antiandrogen drugs used to block the androgen receptor or any drug to delay or suppress normal puberty. D. Policy I. CareSource complies with state and federal regulations for the coverage of medically necessary services. Medically necessary services are health care services needed to diagnose or treat that meet the accepted standards of medicine. 42 C.F.R. 440.230. All requests are reviewed on a case-by-case basis, including any applicable requests under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. II. For any member under the age of 18, Ohio Revised Code 3129.06 prohibits coverage of gender transition services, subject to certain exceptions as follows: A. mental health services provided for a gender-related condition B. treatment, including surgery or prescribing drugs or hormones, to a minor who 1. was born with a medically verifiable disorder of sex development 2. received a diagnosis of a disorder of sexual development 3. needs treatment for any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of gender transition services III. Any member 18 to 20 years of age, as per 42 CFR 441.56 and 42 U.S.C. 1396d(r), will be reviewed for medical necessity as required by the EPSDT program (ie, Ohio Healthchek). CareSource will cover medically necessary care if deemed essential by a healthcare provider, including gender-related care. IV. For any member 21 years of age or older, Ohio Administrative Code 5160-2-03 establishes that gender transformation services are not covered services (eg, clitoroplasty, intersex surgery, vaginectomy, penectomy, mastectomy, breast augmentation). V. All behavioral health services for gender dysphoria will be subject to the same utilization management and cost-sharing requirements as other behavioral and medical benefits in compliance with Mental Health Parity and Addiction Equity Act. 42 U.S.C. 300gg-26; 45 C.F.R. Part 146. Medical Interventions for Gender Dysphoria-OH MCD-MM-0034 Effective Date: 02/07/2026 The MEDICAL Policy Statement detailed above has received due consideration as defined in the MEDICAL Policy Statement Policy and is approved. 4 Dates Action Date Issued 05/18/2017 Date Revised 05/29/2019 09/02/2020 07/07/2021 05/19/2022 06/21/2023 07/17/2024 07/02/2025 Updated evidence, changed policy # (MM-0080), removed pharmacy info, added addtl requirements for surgery, specifics on hair removal, items not covered & types of surgery for medical necessary review. Updated definitions, removed research & codes, added references, changed letter recommendation requirement, changed title. Removed endocrinologist rule, added psych NP & safety info. Annual review. Updated definitions. Added PCP to hormone therapy requirement. Removed conception counseling for genital surgery. Removed breast augmentation from the exclusion list. Annual review. Updated background, definitions, reference list. Approved at Committee. Annual review. Top changed to chest, bottom to genital. Updated background & definitions. Combined letter info. Updated references. Approved at Committee. Rewrote background to comply with 2025 CMS letter. Revised all sections re: compliance with regulations. Approved at Committee. Date Effective Date Archived H. References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revised (DSM-5-TR). Arlington, VA; 2022. 2. Conditions and Limitations. OHIO ADMIN. CODE 5160-2-03 (2022). 3. Definitions. 42 U.S.C. 1396d(r) (2024). 4. Gender Transition Services for Minors. OHIO REV. CODE Chapter 3129 (2024). 5. Healthchek: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Covered Services. OHIO ADMIN. CODE 5160-1-14 (2017). 6. Medicaid Medical Necessity: Definitions and Principles. OHIO ADMIN. CODE 5160-1-01 (2022). 7. Puberty Blockers, Cross-sex Hormones, and Surgery Related to Gender Dysphoria. Centers for Medicare and Medicaid Services; April 11, 2025. Accessed June 11, 2025. www.cms.gov. 8. Required Activities. 42 C.F.R. 441.56 (1984). Approved by Ohio Department of Medicaid 10/24/2025. Medical Interventions for Gender Dysphoria-OH MCD-MM-0034 Effective Date: 02/07/2026E.Conditions Of CoverageNAF.Related Policies/RulesMedical Necessity DeterminationsG.Review/Revision History02/07/2026
Notice Date: To: From: Subject: Effective Date: January 8, 2026Ohio Medicaid and MyCare Providers CareSource Private Duty Nursing Services for Greater than 60-Days July 1, 2024 Summary Providers may request private duty nursing services and home health services for greater than a 60-day period. I mpact Providers may request private duty nursing services and home health services for greater than 60-day period for members with chronic conditions as CareSource does not apply a hard limit of 60 calendar days to private duty nursing and home health authorization periods. CareSource authorizes services in a manner that maximizes the effectiveness of the care provided in accordance with Ohio Administrative Code ( OAC) rule 5160-26-03.1. CareSource takes into consideration the members specific health needs (e.g., whether the member is covered under Healthchek and whether the members health condition is stable, chronic, and/or debilitating) when determining the length of time for which to authorize services. Importance Compliant to OAC Rule https://codes.ohio.gov/ohio-administrative-code/rule-5160-26-03.1 Q uestions? For additional questions, please contact Provider Services at 1-800-488-0134, Monday through Friday, 8 a.m. to 6 p.m. Eastern Time (ET). OH-M ulti-P-3046314
Administrative Policy StatementMarketplace Policy Name Policy Number Date Effective Multi-Source Brand Policy PAD-0005-MPP 7/1/2025 Policy Type Medical ADMINISTRATIVE Pharmacy Reimbursement Administrative Policy Statement s prepared by CSMG Co. and its affiliates (including CareSource) are derived from literature based on and supported by clinical guidelines, nationally recognized utilization and technology assessment guidelines, other medical management industry standards, and published MCO clinical policy guidelines. Clinically appropriate services include, but are not limited to, those health care services or supplies that are proper and necessary for the diagnosis or treatment of disease, illness, or injury and without which the patient can be expected to suffer prolonged, increased or new morbidity, impairment of function, dysfunction of a body organ or part, or significant pain and discomfort. These services meet the standards of good medical practice in the local area, are the lowest cost alternative, and are not provided mainly for the convenience of the member or provider. Clinically appropriate services also include those services defined in any Evidence of Coverage documents, Medical Policy Statements, Provider Manuals, Member Handbooks, and/or other policies and procedures. Administrative Policy Statements prepared by CSMG Co. and its affiliates (including CareSource) do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Administrative Policy Statement. If there is a conflict between the Administrative Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determination. Table of Contents Administrative Policy Statement ……………………………………………………………………………………… 1 A. Subject ………………………………………………………………………………………………………………….. 2 B. Background ……………………………………………………………………………………………………………. 2 C. Definitions ……………………………………………………………………………………………………………… 2 D. Policy ……………………………………………………………………………………………………………………. 2 E. Conditions of Coverage …………………………………………………………………………………………… 3 F. Related Policies/Rules …………………………………………………………………………………………….. 4 G. Review/Revision History ………………………………………………………………………………………….. 4 H. References ……………………………………………………………………………………………………………. 4 Multi-Source Brand Policy Marketplace PAD-0005-MP Effective Date: 7/1/2025 2 A. Subject CareSource uses clinical drug policies that are established, reviewed and approved by the CareSource Pharmacy and Therapeutics (P&T) Committee and the regulatory bodies in each state in which CareSource functions. Policies are reviewed routinely, and a generic medication can be required when the brand name becomes generically available or when it is no longer cost-effective compared to other existing or newer products. For new drugs or new indications for drugs, the P&T Committee generally reviews for policy updates after 180 days from market release. CareSource will follow the guidance of the state Medicaid programs in the states that it services to enforce clinically appropriate lower cost agents as first line therapy. B. Background The intent of CareSource Pharmacy Policy Statements is to encourage appropriate selection of members for therapy according to product labeling, clinical guidelines, and/or clinical studies. The CareSource Pharmacy Policy Statement is a guideline for determ ining health care coverage for our members with benefit plans covering prescription drugs. Pharmacy Policy Statements are written on selected prescription drugs requiring prior authorization or step therapy. The Pharmacy Policy Statement is used as a tool to be interpreted in conjunction with the member's specific benefit plan. NOTE : The Introduction section is for your general knowledge and is not to be construed as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals and is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider can also be a place where medical care is given, like a hospital, clinic or lab. This policy informs providers about when a service may be covered.C. Definitions Allergic Reaction: an allergic reaction, as defined by the American Academy of Allergy Asthma & Immunology, occurs when the immune system overreacts to a harmless substance. Types of allergic symptoms to medications range from skin rashes or hives, itching , respiratory problems, and swelling to anaphylaxis. All medications have the potential to cause side effects, but only about 5 to 10% of adverse reactions to drugs are allergic.1 Clinical Judgment: decisions made within the scope of the expertise of a pharmacist following the review of subjective and objective medical data for a member. A pharmacist can use Clinical Judgment for a benefit determination. If the request is outside the scope of a pharmacists expertise, a benefit determination will be made in collaboration with a medical director. Multi-Source Brand: brand name medication sold or marketed by multiple manufacturers and has therapeutically equivalent generics available. Drug: a medication or substance which induces a physiologic effect on the body of a member (i.e., medication, agent, drug therapy, treatment, product, biosimilar drugs, etc.). Formulary Drug List: a list of prescription drugs which includes a group of selected generic and brand-name drugs which are covered by CareSource. Non-Formulary Drug: a drug not on the Formulary Drug List.D. Policy CareSource will approve the use of multi-source brand medications when the following criteria have been met. This policy will not supersede drug-specific criteria developed and approved by the CareSource P&T Committee nor drug or therapeutic category benef it exclusions. Prior Multi-Source Brand Policy Marketplace PAD-0005-MP Effective Date: 7/1/2025 3 authorization requests should be submitted for each multi-source brand request with chart notes and documentation. I. Member has tried and failed both of the following: A. Two generic manufacturers of the requested brand name medication at an adequate dose for an adequate duration (information must be provided regarding the treatment target or goal that was inadequately met) AND B. All generic alternatives within the same drug class as the requested brand name medication that have an FDA-approved indication to treat the members condition OR II. The member had a serious adverse event with the generic version(s) and the prescriber has provided a copy and confirmation of a MedWatch form submission to the FDA documenting the adverse outcome experienced by the member that includes one of the following (Note: The MedWatch form is available at https://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM163919.pdf ): A. Was life threatening B. Required hospitalization C. Caused disability or permanent damage D. Required intervention to prevent permanent impairment/damage OR III. Member has a history of allergic reaction to an inactive ingredient in the generic product and the prescriber has documented the inactive ingredient, the reaction (dates and clinical details), and the manufacturer of the generic product. IV. Initial approval duration for multi-source brand product request: up to 6 months V. Subsequent approvals may be renewed for up to 12-month durations, such that chart notes are submitted with the request which clearly document all of the following: A. Initial criteria were previously met B. Positive clinical response to therapy with the requested brand name product C. No toxicities or serious adverse reactions have been experienced with the brand name product Requests will not be approved for treatment of non-FDA approved diagnoses or conditions not supported by compendia evidence. Please refer to the Off Label Medication Request policy. Notes: If the requested medication has a Medication Specific Policy, the member will need to meet those requirements in addition to the multi-source brand policy. The start date and duration of the trial must be provided. There must be paid claims if the member was enrolled with CareSource when a trial of a medication occurred. Documented diagnoses must be confirmed by portions of the individuals medical record which need to be supplied with prior authorization requests. These medical records may include, but are not limited to test reports, chart notes from providers office, or hospital admission notes. Refer to the product package insert for dosing, administration and safety guidelines . E. Conditions of Coverage As above. Multi-Source Brand Policy Marketplace PAD-0005-MP Effective Date: 7/1/2025 4 F. Related Policies/Rules Off Label Medication Requests G. Review/Revision History DATES ACTIONDate Issued 08/01/20 18Date Revised 08/01/2020 Reviewed content, transferred to new template, added note about non-coverage of off-label/non-supported use. 10/28/2022 Section D, part I: Changed bullet A to address inefficacy rather than adverse events, since adverse events are addressed in part II. Created criteria to specify durations of approval and requirements for re-authorization. Made grammatical/wording changes f or readability.5/21/2024 Annual review, no updates6/6/2023 Removed medical necessity, updated policy title, updated related policies/rules to align with new policy titles5/21/2024 Annual review, no updates.2/17/2025Updated policy to Multi-source Brand Policy Date Effective 7/1/2025Date Archived H. References 1. deShazo RD, Kemp SF. Allergic reactions to drugs and biologic agents. JAMA. 1997;278:1895906. This guideline contains custom content that has been modified from the standard care guidelines and has not been reviewed or approved by MCG Health, LLC. The Administrative Policy Stateme nt detai led above has r eceived due consi deration as defined in the Administrative Policy Stateme nt Po licy a nd is a pprove d.
How to spend your benefits How to pay in store Swipe your card at checkout or open the mobile app and have the cashier scan your barcode. How to check if an item is covered Use the product scanner in the mobile app to check if an item is covered by your benefits. You can do this in store or at home before you shop. The items listed below are examples of what you can and cannot buy with your benefits. For more details, check your program guide or call the number on the back of your card. Over-the-counter This benefit covers drugstore items that keep you healthy.Whats covered Pain relieversToothpaste and flossAllergy, sinus, cold, and flu medicineFeminine careVitaminsEye and ear careWhats not covered Alternative medicinesContraceptives Flex (dental, vision & hearing) This benefit covers your dental, vision, and hearing needs. Whats covered Dental items and services (routine cleanings, fillings, den tures)Vision items and services (eye exams,glasses, con tacts)Hearing items and services (hearing tests,hearing aids)How to spend your benefit Swipe your card at a valid dental, vision, or hearing pr oviders office or facility that accepts Visa. This is not limited to CareSource participating providers.Y0119_GA-DSNP-M-4500242_C
How to spend your benefits How to pay in store Swipe your card at checkout or open the mobile app and have the cashier scan your barcode. How to check if an item is covered Use the product scanner in the mobile app to check if an item is covered by your benefits. You can do this in store or at home before you shop. The items listed below are examples of what you can and cannot buy with your benefits. For more details, check your program guide or call the number on the back of your card. Over-the-counter This benefit covers drugstore items that keep you healthy.Whats covered Pain relieversToothpaste and flossAllergy, sinus, cold, and flu medicineFeminine careVitaminsEye and ear careWhats not covered Alternative medicinesContraceptives Flex (dental, vision & hearing) This benefit covers your dental, vision, and hearing needs. Whats covered Dental items and services (routine cleanings, fillings, den tures) Vision items and services (eye exams,glasses, con tacts) Hearing items and services (hearing tests,hearing aids) How to spend your benefit Swipe your card at a valid dental, vision, or hearing pr oviders office or facility that accepts Visa. This is not limited to CareSource participating providers.H4193_MI-SNP-M-4582500_C CMS/MDHHS Approved: 10/17/2025
How to spend your benefits How to pay in store Swipe your card at checkout or open the mobile app and have the cashier scan your barcode. How to check if an item is covered Use the product scanner in the mobile app to check if an item is covered by your benefits. You can do this in store or at home before you shop. The items listed below are examples of what you can and cannot buy with your benefits. For more details, check your program guide or call the number on the back of your card. Over-the-counter This benefit covers drugstore items that keep you healthy.Whats covered Pain relieversToothpaste and flossAllergy, sinus, cold, and flu medicineFeminine careVitaminsEye and ear careWhats not covered Alternative medicinesContraceptives Flex (dental, vision & hearing) This benefit covers your dental, vision, and hearing needs. Whats covered Dental items and services (routine cleanings, fillings, den tures)Vision items and services (eye exams,glasses, con tacts)Hearing items and services (hearing tests,hearing aids)How to spend your benefit Swipe your card at a valid dental, vision, or hearing pr oviders office or facility that accepts Visa. This is not limited to CareSource participating providers.H6396_OH-SNP-M-4582154_C Accepted: 10/21/2025
How to spend your benefits How to pay in store Swipe your card at checkout or open the mobile app and have the cashier scan your barcode. How to check if an item is covered Use the product scanner in the mobile app to check if an item is covered by your benefits. You can do this in store or at home before you shop. The items listed below are examples of what you can and cannot buy with your benefits. For more details, check your program guide or call the number on the back of your card.Healthy food * This benefit helps you stock up on groceries that keep you healthy. Whats covered Fruit and vegetables (fresh, frozen, canned) Meat, seafood, plant-based proteins, Cheese, milk, other dairy products Healthy grains, beans, soup, and other pantry items Whats not covered Alcohol and Tobacco (cigarettes, cigars,vaping products) Utilities (rent & mortgage) * This benefit helps you pay your rent, mortgage, and utility bills. Whats covered Rent and mortgage payments Bills for internet, cell phone, cable, gas,electricity, water, garbage, and sewer How to spend your benefit If your utility company accepts Visa, you can pay bills with your benefit. Enter your card info on the utility companys website or pay your bill in Healthy Benefits+. Home improvement & safety * This benefit helps you age in place at home, comfortably and safely. Whats covered Bathroom aids (grab bars, shower chairs,toilet safety rails) General home devices (easy-grip doorknobs, handrails, wheelchair ramps) Pest control (traps, repellent, bait) Indoor air quality (fans, dehumidifiers,space heaters) Whats not covered Tools Paint and wallpaper Installation and professional services Household cleaning * This benefit covers cleaning supplies for your home. Whats covered Cleaning supplies (brooms, mops, rags,cleaning gloves, toilet bowl cleaner) Laundry supplies (detergent, dryer sheets,stain removers, bleach) Paper products (toilet paper, paper towels,paper napkins) Kitchen cleaning (dishwashing soap,sponges, trash bags ) Whats not covered Toilet roll holders Shower curtains Personal care *This benefit cov ers items for daily cleanliness and wellness. Whats covered Skin and oral care (moisturizer, masks, lip balm, mouthwash, tongue scraper) Hygiene (antiperspirant, deodorant, soap,baby wipes) Grooming (shampoo, gel, combs, razors,hair and nail clippers ) Whats not covered Clothing, shoes, and accessories Pet care & supplies * This benefit covers items that support the health, comfort, and wellbeing of dogs and cats. Whats covered Nutrition (dry and wet food, treats) Comfort and living (collars, leashes, food and water bowls, toys, beds) Care and health (crates, carriers, litter, tick prevention, flea shampoo) Whats not covered Veterinary visits Grooming services Medication *Those with one or more listed conditions may qualify for the Healthy Benefits+ allowance for additional items and services. To learn if you qualify, talk to your Care Coordinator. Unused amounts will roll over month-to-month and expire at the end of the year. H6396_OH-SNP-M-4582651_C Accepted: 10/21/2025
© Copyright CareSource 2026. All rights reserved.
System Details