Plan Documents

Review your CareSource marketplace plan documents to make sure you get the most from your health insurance plan. You can also contact us with any questions you have about your plan coverage.

Marketplace Plans

CareSource Gold Plans

CareSource 2019 Gold

Higher premiums and lower out of pocket costs.

If you expect to have a lot of doctor appointments, need many prescription medicines, or need other health services, this may be a good choice for you. Gold plans have:

Higher premiums. You pay more each month for a Gold plan than you would for another metal level.

Lower out-of-pocket costs. With a Gold plan, the amount you pay each time you get a health service, such as seeing a doctor or filling a prescription, is less than what you’d pay if you have a Bronze or Silver plan.

CareSource Silver Plans

CareSource 2019 Silver

Our only plans offering cost sharing reductions (CSRs).

The CareSource Silver Plan is our most popular plan. In fact, 50% of our members find that it fits best into their lifestyle and budget.

Financial Assistance – These are the only plans where you can take advantage of cost sharing reductions (CSRs). If you qualify for CSRs, they will lower your out-of-pocket costs – deductibles, copayments, and coinsurance. Eligibility for CSRs is determined by the Health Insurance Marketplace and is based upon your household size and income.

Low Premium Plan Option reduces your overall premium while still allowing for CSRs.

Low Deductible Plan Option allows you to prioritize reducing your out-of-pocket costs at a higher monthly premium.

Standard Silver Plan Option offers a balance between our Low Premium and Low Deductible options.

CareSource Bronze Plans

CareSource 2019 Bronze

Lowest premiums and highest out of pocket costs.

If you don’t expect to have many doctor appointments or need many prescription drugs, this may be a good choice for you. Bronze plans have:

Lowest premiums. You pay less each month for a Bronze Plan, but these plans have the highest deductibles and other out-of-pocket costs.

Standard Bronze – This plan focuses on keeping premiums low, while still enabling preventive services and other more common health care needs before you need to satisfy your deductible such as primary care or retail clinic visits and some prescriptions.

HSA Eligible – A CareSource marketplace plan designed to be compatible with a tax advantaged Health Savings Account (HSA). Outside of preventive services, you’ll need to satisfy your deductible before CareSource contributes to your health care costs.

Member Handbook

The Member Handbook is a quick reference guide to your health care benefits. It allows you to quickly look up information such as how to contact us, how to request an ID card and how to pay your bill.

Evidence of Coverage (EOC)

The EOC is an important legal document that describes the relationship between CareSource, and CareSource members. It serves as your contract with CareSource and describes CareSource members’ rights, responsibilities and obligations. It also tells you how the plan works, the covered services you are entitled to, any conditions and limits related to covered services, the health care services that are not covered by the plan, and the annual deductible, copayments, and coinsurance you must pay when you receive covered services.

Consumer Justification Narrative

Glossary

Forms

We want you to easily find the forms you need for your CareSource marketplace plan. Visit the Forms page to find any form when you need it.

DISCLAIMERS

CareSource is a Qualified Health Plan issuer in the Health Insurance Marketplace. This is not a Health Insurance Marketplace website. This website does not display all available Marketplace plans. To see all available Qualified Health Plan options available, go to www.healthcare.gov.

This website is subject to change at any time without prior notice. This website is intended only as general information and is not an offer or invitation to contract.

This is a solicitation for health insurance. All covered health care services must be received by in-network providers, except as otherwise required by applicable law, and subject to policy limitations and exceptions. Benefits, premiums, deductibles and copays may vary based on individual circumstances and plan selection. For complete details of coverage, limitations and exclusions, please review the CareSource Marketplace 2019 Evidence of Coverage and Schedule of Benefits documents at CareSource.com/marketplace.

Specific policy benefits listed on this website are intended to be a summary of coverage and do not list or describe all the benefits covered under specific policies nor is every limitation, exclusion or reduction of benefits listed. The overview of benefits, coverage and member cost shares are based on benefits being received from an in-network provider. To be eligible for reimbursement, all health care services must be provided by an in-network provider, except when applicable federal and state law or the applicable Evidence of Coverage for each policy provide otherwise.

Rates, benefits, premiums, deductibles, co-payments, co-insurance, and out of pocket expenses may vary based upon a variety of factors, including but not limited to, age, county of residence, smoking status, and level of policy selected.

References to CareSource pertain to each individual company or other CareSource affiliated companies, such as CareSource, CareSource Kentucky Co., CareSource Indiana Inc., and CareSource West Virginia Co. Each company is a separate entity and is not responsible for another’s financial condition or contractual obligations.

CareSource does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.


ADV-WebPlanDocs(WVRev.3/2019)-0611
WV-EXCM-0611
WVOIC Approved 04/03/2019

Last updated 06/04/2019