Sample notices for beneficiaries about NC Medicaid.
Transition Notices
Tailored Plan Mandatory - Notice to beneficiaries who were enrolled in the Tailored Plan.
English l Spanish
Tailored Plan (Standard Plan) - Notice to beneficiaries who were enrolled in the Tailored Plan and can choose a Standard Plan.
English l Spanish
Tailored Plan (NC Medicaid Direct) - Notice to beneficiaries who were enrolled in NC Medicaid Direct and can choose the Tailored Plan or stay in NC Medicaid Direct.
English l Spanish
Tailored Plan (Standard Plan, NC Medicaid Direct) - Notice to beneficiaries who were enrolled in another health care option and can choose the Tailored Plan, a Standard Plan or stay in NC Medicaid Direct.
English l Spanish
Tailored Plan (EBCI Tribal Option, NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary who was enrolled in another health care option and can choose the Tailored Plan, EBCI Tribal Option or NC Medicaid Direct
English l Spanish
Tailored Plan (EBCI Tribal Option, Standard Plan, NC Medicaid Direct) - Notice to federally recognized tribal member or IHS-eligible beneficiary who was enrolled in another health care option and can choose the Tailored Plan, a Standard Plan, EBCI Tribal Option or NC Medicaid Direct.
English l Spanish
Enrollment Packet
Services Covered Outside Health Plans
English l Spanish
Drug List and Copays Insert
English l Spanish
Health Care Option Guide
English l Spanish
Enrollment Form - Standard Plan
English l Spanish
Enrollment Form - Tailored Plan
English l Spanish
Enrollment Form – Exempt Tribal
English l Spanish
Tailored Plan - Disenrollment Rights Insert - Version 1
English l Spanish
Tailored Plan - Disenrollment Rights Insert - Version 2
English l Spanish
Appeals and Grievances
Grievance Acknowledgement Notice
English l Spanish
Grievance Resolution Notice
English l Spanish
Other Beneficiary Notices
Tailored Plan Delay Notice
English | Spanish
This page was last modified on 03/20/2023