We want you to easily find the forms you need for your CareSource plan. Listed below are all the forms you may need as a CareSource member.
Explanations of when and why you may need to use a form are also provided below. Look for instructions on each form. The instructions will tell you where you need to return each form, who to contact if you have questions and any next steps to take. Forms may be downloaded for printing.
Tell Us – Use this form when you would like to send us a question or request online.
Grievance/Appeal Form – Use this form when you have a complaint about service you have received or would like to dispute a decision that has been made.
Member Consent/HIPAA Authorization Form– Use this form to give your consent to share your health information with your providers and/or release health information to someone you name. Or, download this hard-copy version and mail or fax the completed form to us. Please allow up to 30 days to process the hard-copy form.
IRS 1095B Information
- IRS 1095B Form
- Letter from Georgia Department of Community Health
- More Information
- Frequently Asked Questions about the 1095B Tax Form
Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.