North Carolina Essential Plan

Important Member Documents

As a valued member of Provider Partners Health Plans in North Carolina, you can access your important documents at any time by clicking on the links below.

Member Materials

• 2026 Annual Notice of Change
• 2026 Essential Plan Summary of Benefits
• 2026 Evidence of Coverage
• 2026 Star Ratings
• 2026 LIS Summary
• 2026 LIS Summary (Spanish)
• Appointment of Representative Form CMS-1696
• Member Reimbursement Form Part C
• Member Reimbursement Form Part D
• Participating Providers
• Participating Pharmacies
• Appeals, Organizational Determinations, Coverage Determinations, Grievances
• Over The Counter (OTC) Catalog – coming soon

Pharmacy resources

• Pharmacy Resources

Enrollment

• Enrollment Process
• 2026 Enrollment Form
• Disenrollment Process

Medical Information and Authorization

• 2026 Authorization Form