Your $0 Preventive diabetes & healthy heart care plan

Congratulations on enrolling in our $0 Preventive diabetes & healthy heart care plan!

Now that you have your plan, start right by making an appointment with your in-network family doctor and/or cardiologist. If you don’t have a provider that is in-network, use our Find a Doctor tool to find one now.

Take your $0 Preventive diabetes & healthy heart care plan guide with you. You can view or download it from the Plan Documents page.

As a $0 Preventive diabetes & healthy heart care plan member, you may get many drugs, services, and supplies at $0 cost to you! If you need:

  • Any of the $0 Preventive diabetes and healthy heart medical services, such as a cholesterol (LDL) or A1C test, get them.
  • Any of the $0 Preventive diabetes and healthy heart drugs* listed on your plan guide, and if they are appropriate for your condition, ask your provider for a new prescription.
  • A glucose meter and test strips, or similar $0 self-management supplies, ask your provider to write a prescription for them. You can take it to an in-network pharmacy or send to our mail order pharmacy.

* Prior authorization, quantity limits or step therapy may be required.

Home delivery can save you time and help make sure you have the medicines you need. Sign-up with our mail order pharmacy. It’s a convenient way to have a 90-day supply delivered right to your door! Ask your provider to ‘e-prescribe’ a 3-month supply to Express Scripts. Your provider should already have the website and phone number.

Plan Costs

Learn more about your plan’s costs by reviewing your Schedule of Benefits.

Join Our Coaching Program

This plan is focused on prevention rather than treatment. Although you are covered for treatment of any sickness or disease, just as you are with any CareSource Marketplace plan, your greatest savings will be found with preventive care. Your $0 cost drugs and tests cover preventive treatment and care for both diabetes and heart conditions. If your doctor has prescribed a listed drug for treatment purposes (and not preventive purposes) then your plan does not provide coverage for that drug before your deductible is satisfied.

Learn more about diabetes, heart disease and how to treat them. Get tips and help with diet, exercise, medications and lifestyle changes. Call our Care Management team at 1-833-230-2037 to request a Care Manager and start your coaching program today!

Questions?

Call Member Services at 1-833-230-2099 (TTY: 711). We’re happy to help you:

  • Answer any questions
  • Find an in-network provider or pharmacy
  • Get language assistance such as material in another format

*Some drugs and services require pre-authorization from us before you get them. Check the Drug Formulary.

IMPORTANT REMINDER for HDHP HSA PLANS:

Your coverage includes a preventive drug benefit. Some medications that help prevent chronic conditions and illnesses are covered before you meet your deductible. Keep in mind:

  • Some of these drugs can also be used for treatment purposes.
  • If the drug is for treatment of a condition, you will need to meet your HDHP deductible before that drug will be covered by the plan.

About HSAs and tax rules. Health Savings Accounts (HSAs) have tax and legal ramifications^. CareSource cannot guarantee or provide any legal advice on the way these products are prescribed for preventive purposes or that the IRS would agree that all satisfy the definition under §223 NOTICE 2019-45.

What you need to do. As everyone’s medical situation is different. That’s why it’s important to confirm the purpose of the prescription with your doctor. Take these steps to properly classify your prescription. Find your drug on the list and ask your doctor if the drug is prescribed for prevention or treatment purposes.

  1. If the drug is for treatment:
  • Call the number on your member ID card. Tell us the prescription that will be used to treat your condition so we can make sure it is processed correctly.
  • The wrong classification can cause tax and claims problems. If you don’t call us, the claim will be processed as preventive. Then you or your doctor may be asked to send medical records showing how the drug is used for prevention.
  1. If the drug is for prevention, you do not need to call us.

^Consult your financial professional. This is not financial advice.