Plan Documents

Review your plan documents to make sure you get the most from your health plan. you would like a printed copy of these documents, please call Member Services and we can mail it to you. You can also find additional plan documents in your CareSource MyLife account.

Member Handbook/Evidence of Coverage

Your Navigate Member Handbook/Evidence of Coverage is a guide to your health care benefits. It tells you how our plan works, the covered services you get, services that are not included and your rights and responsibilities.

Summary of Benefits

The Summary of Benefits includes your covered benefits and any limitations. This is only a summary. View your Evidence of Coverage for a full list of benefits.

Benefits at-a-Glance

Use the Navigate Benefits at-a-Glance  (updated 10/1/2025) to put your benefits to work for you! This is only a guide. View your Evidence of Coverage for a full explanation of your benefits.

Annual Notice of Change

The Annual Notice of Change outlines the changes to your benefits for the next plan year.

Provider/Pharmacy Directory

The Find a Doctor tool has our most up-to-date list of network providers. You will find office hours, whether the office is on a bus line, if the provider is seeing new patients and more. The Find a Pharmacy tool has the most updated list of pharmacies.

Prior Authorization List

Prior Authorization is the approval that may be needed before you get a service. The service must be medically necessary for your care. Your provider will take care of this for you. View the full list of services that need prior authorization.

Your provider can submit a request for a prior authorization using the Prior Authorization Request Form (coming soon).

Prescription Drug Benefit Documents

  • List of Covered Drugs (Formulary)– A list of all drugs covered under your plan.
  • Notice of Formulary Changes – Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates. 
    • Notice of Formulary Changes (Coming Soon)
  • Preferred Diabetic Supply List – We cover diabetic testing supplies. This list has the preferred products.
    • Preferred Diabetic Supply List (Coming soon)
  • Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.
  • Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed.
  • Drug Transition Policy – Learn about our policy for potentially covering a drug you currently take that is not listed in our formulary.
  • Navigate Coverage Determination Request Form– If you believe you are entitled to payment or coverage on a certain drug, you can request a coverage determination by completing this form.
  • Navigate Coverage Redetermination Request Form – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form.