Resources / Materials

• 2024 Annual Notice of Changes - English (PDF)
• 2024 Annual Notice of Changes - Spanish (PDF)

• 2024 OH H0022 MMP Member Handbook - English (PDF) - coming soon
• 2024 OH H0022 MMP Member Handbook - Spanish (PDF)  - coming soon
  

• MyCare Ohio Member Handbook for Medicaid-Only Members (PDF)  - coming soon
  This Member Handbook, or Evidence of Coverage, tells our members how their benefits work for Buckeye Ohio Medicaid. Members should contact Original Medicare, or their Medicare Health Plan for information about their Medicare benefits.

• MyCare Ohio Waiver Handbook for Medicaid Members on a Waiver (PDF)  - coming soon
  This Waiver Handbook tells our members how their benefits work in Buckeye’s integrated care delivery system Ohio Medicaid waiver.
  
  
• MyCare Ohio Self-Direction Handbook for Medicaid Members on a Waiver (PDF) - Coming soon
  This Self-Direction Handbook gives information for waiver members who wish to be more involved with recruiting, hiring, training, and managing aides and health care workers for certain types of waiver services.

• How to request a Member Handbook- English (PDF)
• How to request a Member Handbook - Spanish (PDF)

• 2024 Summary of Benefits - English (PDF) - coming soon
• 2024 Resumen de Beneficios - Spanish (PDF) - coming soon

• Prescription Drug Claim Form-English (PDF)
• Prescription Drug Claim Form-Spanish (PDF)

• Express Scripts Mail Order Form-English (PDF) - Coming in December 2023
• Express Scripts Mail Order Form-Spanish (PDF) - Coming in December 2023

• List of Drugs (Formulary)

• List of Drugs Change Notice

• Drug Coverage Determination
• Drug Redeterminations (Appeals)

• Part D Prior Authorization Criteria Form

• Part D Step Therapy Criteria Form

• Appointment of Representative Form-English (PDF)
• Appointment of Representative Form Spanish (PDF)

Please note: By clicking on these links you will be leaving the Buckeye website.

• 2-1-1 by United Way Worldwide (UWW) and the Alliance for Information and Referral Systems (AIRS)
• CMS-1696 Appointment of Representative Form (PDF),
• CMS Best Available Evidence (BAE) policy
• File a complaint directly with CMS
• Information to help prevent, report and stop Fraud, Waste, and Abuse
• Medicare Prescription Drug Plan Finder
• Office for Civil Rights
• The Office of the Medicare Ombudsman (OMO)
• To compare other plan ratings, find detailed reports on the findings, or to get the most recent rating information for Buckeye Community Health Plan go to: www.medicare.gov.
• Pain Management and Medication Abuse Prevention

• Covered Diabetes Testing Supplies (PDF)

Your current health plan offers an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. The catalog includes a list of OTC items that you can order and have mailed directly to your home.

There are three ways to order—in store, online, or by phone.  You can also download the new OTC Health Solutions App. The app is an easy and quick way to scan items in store, view your benefit information and items offered, process an order, review past orders, and look up account information. Ordering is easy. Just follow the steps in your plan's catalog.

Click on the OTC Catalog link below for all of your benefit details:

• Over-the-Counter Catalog - English (PDF) - coming sooon
• Over-the-Counter Catalog - Spanish (PDF) - coming soon

You can also connect to CVS® OTC Health Solutions to review products and store information.

• 2023 Annual Notice of Changes - English (PDF)
• 2023 Annual Notice of Changes - Spanish (PDF)

• MyCare Ohio Member Handbook for Dual Members (Medicare + Medicaid) 
  • 2023 OH H0022 MMP Member Handbook - English (PDF)
  • 2023 OH H0022 MMP Member Handbook - Spanish (PDF)

• MyCare Ohio Waiver Handbook for Medicaid Members on a Waiver (PDF)
  This Waiver Handbook tells our members how their benefits work in Buckeye’s integrated care delivery system Ohio Medicaid waiver.
  

• How to request a Member Handbook by Mail - English (PDF) 
• How to request a Member Handbook by Mail - Spanish (PDF) 

• 2023 Summary of Benefits - English (PDF)
• 2023 Resumen de Beneficios - Spanish (PDF)

• Prescription Claim Form - English (PDF)
• Prescription Claim Form - Spanish (PDF)
• CVS Caremark Form - English (PDF)
• CVS Caremark Form - Spanish (PDF)

Please note: By clicking on these links you will be leaving the Buckeye website.

• 2-1-1 by United Way Worldwide (UWW) and the Alliance for Information and Referral Systems (AIRS)
• CMS-1696 Appointment of Representative Form (PDF),
• CMS Best Available Evidence (BAE) policy
• File a complaint directly with CMS
• Information to help prevent, report and stop Fraud, Waste, and Abuse
• Medicare Prescription Drug Plan Finder
• Office for Civil Rights
• The Office of the Medicare Ombudsman (OMO)
• To compare other plan ratings, find detailed reports on the findings, or to get the most recent rating information for Buckeye Community Health Plan go to: www.medicare.gov.
• Pain Management and Medication Abuse Prevention

• Covered Diabetes Testing Supplies (PDF)

Your current plan offers an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed to your home. Check the catalog for your benefit details and item limits.

• Ordering is easy. Just follow the steps in your plan's catalog. 
• Over-the-Counter Catalog - English / Spanish (PDF)

Don't want to wait? You may be able to pick up your OTC products from a CVS® store near you.  Please note this does not include CVS® locations inside of Target stores.

Connect to the CVS® OTC Health Solutions to review available products and store information.