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Plan documents from iCare provider directories to Evidence of Coverage and Summary of Benefits and more.

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Check out our library of helpful information, from plan brochures to provider directories. Filters make it easy to find what you're looking for. If you have any questions about any of the information in our library or can't find something, give us a call. We are here to help!

To locate a Medicare Advantage coverage policy referenced in a letter you received, please refer to Humana’s Medical and Pharmacy Coverage Policies; iCare is a subsidiary of Humana, and coverage policies are located on Humana’s Medical and Pharmacy Coverage Policies page. Enter the number or name of the policy referenced in your letter in the keyword search box on this page.

iCare Health Plan also utilizes Care Guidelines to determine medical necessity for the plans that we manage. The Guidelines are the protected intellectual property of MCG. iCare Health Plan is not able to distribute them without the permission of MCG. MCG has provided a tool that allows iCare Health Plan members and prospective members to view relevant MCG guidelines, however you will not be able to print them.


Follow the instructions below to access the MCG Guidelines:

  1. Access guidelines here, read the disclaimer, and accept the terms and conditions.
  2. Complete the User information form.
  3. Complete the verification process to continue.
  4. Click on the arrow icon.
  5. Click on the guidelines you wish to view.

iCare has prepared some FAQs for Medicare Advantage coverage policies.

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Member Documents that match your criteria:

2026 FCP Annual Notice of Changes

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information

2026 FCP Evidence of Coverage - Updated 1/6/26

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

2026 FCP Over the Counter (OTC) Catalog

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information

2026 FCP Summary of Benefits - Updated 1/6/26

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

2026 iCare FCP D-SNP Provider & Pharmacy Directory - Updated 9/1/26

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

2026 Part D Coverage Determination

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents
  • Grievances & Appeals

Appeals Request Form

Document Types
  • Claims
  • Policies and Guidelines

BadgerCare and SSI Plan Brochure

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Plan Information

BadgerCare Plus & Medicaid Mom & Baby Program

Plans
  • iCare BadgerCare Plus
Document Types
  • Health Education
  • Programs

BadgerCare Plus SSI Member Handbook

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Plan Information

BadgerCare Plus Welcome Guide

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Health Education
  • Plan Information

Claim Form - LTC Professional

Plans
  • iCare Family Care Partnership
Document Types
  • Claims
  • Provider Forms

CMS Appointment of Representative Form

Plans
  • iCare Family Care Partnership
Document Types
  • Applications
  • Claims
  • Policies and Guidelines

CMS Appointment of Representative Form - SP

Plans
  • iCare Family Care Partnership
Document Types
  • Applications
  • Claims
  • Policies and Guidelines

Consent to Receive Electronic Communications

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

DHS In Lieu of Services Guidance-Medically Tailored Meals

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Policies and Guidelines
  • Prior Authorization

DSNP DMR Claims Form

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

DSNP DMR Claims Form - SP

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

Family Care Partnership Medicaid Member Handbook

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

FCP HMO DSNP Diabetic Supplies List

Document Types
  • Formulary/ Pharmacy Documents
  • Prior Authorization

FCP Medicaid Only Diabetic Supplies List

Document Types
  • Benefit Information
  • Formulary/ Pharmacy Documents

FCP Self-Directed Supports Brochure

Plans
  • iCare Family Care Partnership

FCP Self-Directed Supports Guidebook

Plans
  • iCare Family Care Partnership

I Speak "Fill in the blank" template

Plans
  • ALL
Document Types
  • Health Education

I Speak Arabic

Plans
  • ALL
Document Types
  • Health Education

I Speak Burmese

Plans
  • ALL
Document Types
  • Health Education

I Speak Chinese

Plans
  • ALL
Document Types
  • Health Education

I Speak Hmong

Plans
  • ALL
Document Types
  • Health Education

I Speak Lao

Plans
  • ALL
Document Types
  • Health Education

I Speak Russian

Plans
  • ALL
Document Types
  • Health Education

I Speak Somali

Plans
  • ALL
Document Types
  • Health Education

I Speak Spanish

Plans
  • ALL
Document Types
  • Health Education

I Speak Ukrainian

Plans
  • ALL
Document Types
  • Health Education

I Speak Vietnamese

Plans
  • ALL
Document Types
  • Health Education

iCare Formulario de solicitud de participación en el Plan de Pago de Medicamentos Recetados de Medicare (MP3)

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

iCare Limited English Proficiency Policy Statement

Document Types
  • Policies and Guidelines

iCare Medicaid SSI - BadgerCare Plus Provider Directory - updated 9/1/26

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

iCare Medicaid SSI Intensive Care Management brochure

Plans
  • iCare Medicaid SSI
Document Types
  • Programs

iCare Medicare Prescription Payment Plan (MP3) Opt in Form

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

iCare Member Safety and Risk Policy

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

iCare Transition Policy Rx Drug Coverage

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

Incident Reporting Guide for Members

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education

Medicaid Appointment of Representative DHS Form-ORGANIZATION

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Applications

Medicaid Appointment of Representative DHS Form-PERSON

Plans
  • iCare Family Care Partnership
  • iCare Medicaid SSI

Medicaid Appointment of Representative Form - Grievance and Appeal

Plans
  • iCare Family Care Partnership
  • iCare Medicaid SSI

Medicaid Auxiliary Aids and Services Notice

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Medicaid Auxiliary Aids and Services Notice SP

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Policies and Guidelines

Medicaid SSI Welcome Guide

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Health Education
  • Plan Information

Medicare - Notice of Availability - Auxiliary Aids and Services Notice

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

Medicare Advantage Medical Coverage Policies FAQs

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines
  • Prior Authorization

Medicare Member Coverage Determination Form

Plans
  • iCare Family Care Partnership

Medicare Stars Rating

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

Medication Reconciliation Post-Discharge Form

Plans
  • ALL
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Forms

Non-Discrimination Notice

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Policies and Guidelines

Notice of Privacy Practices

Document Types
  • Policies and Guidelines

Nurse Advice Line Brochure

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education

Nurse Advice Line Brochure- SP

Document Types
  • Health Education

Ombuds Information

Plans
  • ALL
Document Types
  • Claims
  • Grievances & Appeals

Ombuds Information- HM

Document Types
  • Health Education
  • Policies and Guidelines

Ombuds Information- SP

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education
  • Policies and Guidelines

PCW Information for BC+ or SSI Members

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Policies and Guidelines
  • Prior Authorization

Personal Medication List (blank)

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Privacy Practices Policy

Plans
  • ALL
Document Types
  • Policies and Guidelines

Request for a State Fair Hearing

Document Types
  • Applications
  • Policies and Guidelines

Understanding Abuse Neglect and Exploitation

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education

What to do in Case of an Emergency

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Wisconsin Tobacco Quit Line Fact Sheet

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Wisconsin Tobacco Quit Line Fact Sheet - SP

Plans
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

H2237_IC2203_M_CMS Review 9/22/25
DHS Approved 3/20/26_Last Updated 8/1/26

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