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 and 2020 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 and 2020 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.

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.

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.

CareSource Bronze Plans

CareSource 2019 and 2020 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.

Access the EOC below that corresponds to your plan:

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.


ADV-WebPlanDocs/Benefits(WV2020)-0775
WV-EXCM-0775
WVOIC Approved 10/16/2019

Last updated: 10/23/2019