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Click here to register for the new Hally member portal.

1095-B tax forms are now available. You can download your 1095-B form by logging in at or by downloading the new MyChart app (and registering your account and signing in). For questions or to request a printed copy of your 1095-B, email us at, contact us at (877) 933-0015 or mail your request to FirstCarolinaCare, 3310 Fields South Dr., Champaign, IL 61822.

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Coverage Decisions, Appeals, and Grievances

for Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage)

How do I file a grievance?

To file or check the status of a grievance or an appeal‚ the first step is to call Member Services. Member Services can also assist members with requests to obtain an aggregate number of grievances, appeals, and exceptions filed with the Plan/Part D sponsor.

Member Services

(877) 210-9167 (TTY 711)

Daily 8 a.m. to 5 p.m. local time, closed from noon to 1 p.m.
Voicemail used on holidays and weekends, April 1 – September 30

(844) 499-5630

(800) 984-3510 (TTY 711)

(855) 291-9336

Daily 8 a.m. to 8 p.m. local time
Voicemail used on holidays and weekends, April 1 – September 30

File by mail

If you do not wish to call or you called and were not satisfied, you can put your complaint in writing and send it to the address or fax below. Be sure to describe your complaint.

FirstCarolinaCare Insurance Company
Attention: Appeals Department
3310 Fields South Dr.
Champaign, IL 61822
Fax: (217) 902-9708

FirstCarolinaCare Insurance Company
Attention: Grievance Department
3310 Fields South Dr.
Champaign, IL 61822

The following document contains detailed information if you wish to appoint a representative to file the complaint on your behalf.

Appointing a Representative

What if I don’t want to file my complaint through FirstCarolinaCare Insurance Company?

You can also go directly through or call (800) MEDICARE to file a complaint.

You can also get help with Medicare-related complaints, grievances, and information requests from Medicare's Ombudsman.

How do I request a coverage determination or medical exception for a drug?

You, your authorized representative, or your prescribing doctor can use our Coverage Determination Request Form to ask for a coverage determination. Send any additional chart notes in one of the following ways:


FirstCarolinaCare Insurance Company
Attention: Pharmacy Department or Medical Management
3310 Fields South Dr.
Champaign, IL 61822



(217) 902-9798