The Cal MediConnect Program through Health Net
|
|
- Emil Green
- 6 years ago
- Views:
Transcription
1 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) The Cal MediConnect Program through Health Net Health benefits and services for people who are eligible for both Medi-Cal and Medicare What is Cal MediConnect? Medi-Cal and Medicare have partnered to offer Cal MediConnect. This program is designed to better serve California s low-income seniors and persons with disabilities by improving the way health care is accessed and delivered. Health Net will take care of your needs as a member of the Health Net Cal MediConnect plan. Cal MediConnect will: Improve health care services for people enrolled in Medicare and Medi-Cal (also known as dual eligibles ). Help you stay healthy and live independently in your home for as long as you can. Help to make your health care simple: One health plan to manage your care One phone number to call One member ID card What benefits do I get? Cal MediConnect is a comprehensive medical and prescription drug health plan. The program gives you all your Medicare and Medi-Cal services in one plan. It includes: Routine vision care and eyewear Unlimited transportation Added dental care Worldwide emergency care Routine podiatry Prescription drug coverage 24-hour nurse advice line Home and community-based services Behavioral health care Long-term and acute care H3237_2017_0006 CMS Approved
2 What is care coordination? Care coordination is a way to manage your Medicare and Medi-Cal health care and social services through one managed care plan, like Health Net. Health Net works with members, their families and caregivers to provide the information needed to improve their health care and access to home and community-based services. We make sure members get the right treatment for their condition. We make sure a member s health care is not duplicated by mistake. Questions? Want to find out more about Cal MediConnect? Give Health Net a call at (TTY: 711), Monday through Friday, 8:00 a.m. to 8:00 p.m. The call is free. We re here to answer your questions and help you understand your options. In-Home Supportive Services (IHSS) Caregiver Engagement Program The IHSS Caregiver Engagement Program is a unique program offered by Health Net to help caregivers better support the people they care for in many important ways. The training will give your caregiver the skills and support to become a member on your care team. Your caregiver will be given $40 a month once he or she has finished the training class and completed a required weekly health report. Your caregiver will get this extra pay as long as you are a member of Health Net s Cal MediConnect Plan. Award-winning cultural and linguistic program Health Net received the Multicultural Health Care Distinction from the National Committee for Quality Assurance for Medicare and Medi-Cal. This means that no matter where you are from or what language you speak, Health Net will make sure you get quality health care that is fair and easy to understand. (Resource: National Committee for Quality Assurance (NCQA). This designation was not given by Medicare, and expires on 12/7/2017 but is up for renewal every 2 years. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call Health Net Cal MediConnect Member Services or read the Health Net Cal MediConnect Member Handbook. Benefits and/or copayments may change on January 1 of each year. Copayments for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details. Health Net Community Solutions, Inc. is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Health Net Community Solutions, Inc. is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved. FLY007200EO00 (10/16)
3 Non-Discrimination Language (CMC) Health Net Cal MediConnect complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Health Net Cal MediConnect does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Health Net Cal MediConnect: Provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, other formats). Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact Health Net Cal MediConnect's Customer Contact Center at in Los Angeles County and in San Diego County: (TTY: 711), Monday through Friday, 8:00 a.m. to 8:00 p.m. At other times including Saturday, Sunday and federal holidays you can leave a voic . We will return your call the following business day. The call is free. If you believe that Health Net Cal MediConnect has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance by calling the number above and telling them you need help filing a grievance; Health Net Cal MediConnect's Customer Contact Center is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD: ). Complaint forms are available at
4 Multi-Language Insert Multi-language Interpreter Services English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al Chinese: 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (Los Angeles), (San Diego) (TTY: 711) Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa French: ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (Los Angeles), (San Diego) (TTY: 711). German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: H3237_2017_0096 CMS Accepted
5 Korean: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 번으로전화해주십시오. Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (Los Angeles), (San Diego) (телетайп: 711). Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم - Diego), (San Angeles) (Los )رقم هاتف الصم والبكم: 711(. Hindi: ध य न द : यदद आप ब लत ह त आपक ललए म फ त म भ ष सह यत स व ए उपलब ध ह पर क ल कर. Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para French Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer
6 Japanese: 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (Los Angeles), (San Diego) (TTY: 711). まで お電話にてご連絡ください Farsi: توجه: اگر به زبان فارسی گفتگو می کنید تسهیالت زبانی بصورت رايگان برای شما فراهم با 711) (TTY: (San Diego), (Los Angeles) تماس بگیريد. می باشد. Armenian: ՈՒՇԱԴՐՈՒԹՅՈՒՆ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք (Los Angeles), (San Diego) (TTY (հեռատիպ) 711): Cambodian: ប រយ ត ន បរ ស នជ អ នកន យ យ ភ ស ខ ម រ, បសវ ជ ន យខ នកភ ស ប យម នគ ត ឈ ន ល គ អ ចម នស រ រ រ បរ អ នក ច រ ទ រស ព ទ Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau Punjabi: ਧ ਆਨ ਧ ਓ 1 ਹ ਧ ਲ ਤਸ ਲਲ ਸ ਜ ਜ ਜ ਜ ਜ ਜ ਧ ਵ ਜ ਜ ਤ, ਦ ਦਲ ਜ ਬ ਜ ਪ ਸ ਤ ਜ : (Los Angeles), (San Diego) (TTY: 711) ਲ ਦਹ ਲਜਲ ਜ' Thai: เร ยน: ถ าค ณพ ดภาษาไทยค ณสามารถใช บร การช วยเหล อทางภาษาได ฟร โทร (Los Angeles), (San Diego) (TTY: 711).
7 FLY009695ZO00 (8/16)
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax:
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Fax Number: Kaiser Permanente 1-866-206-2974 Attention: Medicare Part D Review P.O. Box
More informationRequest for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because we [Part D plan sponsor] denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us
More informationRequest for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because we [Part D plan sponsor] denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us
More informationAdvance Directives Information Sheet
What are Advance Directives? Advance Directives Information Sheet An Advance Health Care Directive (also known as an Advance Directive ) is a form that helps others give you the care you would want when
More informationRequest for Redetermination of Cal MediConnect Prescription Drug Denial
Request for Redetermination of Cal MediConnect Prescription Drug Denial Because we, Health Net Cal MediConnect Plan (Medicare-Medicaid Plan), denied your request for coverage of (or payment for) a prescription
More informationH3237_2018_LACareCoor_CMB_Accepted_ Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
H3237_2018_LACareCoor_CMB_Accepted_12122017 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Health Net Cal MediConnect Nondiscrimination Notice Health Net Community Solutions, Inc. (Health Net
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Florida Hernando, Hillsborough, Miami-Dade, Pasco, Pinellas H1032 Plan 174 1/1/2018 12/31/18 WellCare Essential (HMO-POS) H1032_WCM_02981E WellCare 2017
More informationTake This Quiz. Are you getting both Medicare and Medi-Cal benefits? YES NO. Do you need help finding doctors, specialists and other providers?
Attention Los Angeles County Residents! Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Take This Quiz Learn if you might benefit from Cal MediConnect Start the quiz! Are you getting both Medicare
More informationMEDICARE & MEDICARE-MEDICAID DRUG COVERAGE DECISION REQUEST This form may be sent to us by mail or fax:
MEDICARE & MEDICARE-MEDICAID DRUG COVERAGE DECISION REQUEST This form may be sent to us by mail or fax: Address: Fax Number: Health Net 1-800-977-8226 Attn: Prior Authorization PO Box 419069 Rancho Cordova,
More informationRequest for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because we Blue Cross Medicare Advantage Dual Care (HMO SNP) SM denied your request for coverage of (or payment for) a prescription drug,
More informationHospital stay Medical equipment (such as wheelchairs, walkers and oxygen) Rehabilitation services Occupational, physical or speech therapy Eye exams
$ 0 monthly premiums Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Benefit Highlights You can enroll in Health Net Cal MediConnect if you are eligible for Medicare and Medi-Cal and live in the
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Georgia Barrow, Bryan, Butts, Chatham, Chattahoochee, Cherokee, Clayton, Cobb, Columbia, DeKalb, Douglas, Fayette, Forsyth, Fulton, Glynn, Gwinnett, Harris,
More informationSummary of Benefits. H1777_2018SOB_Accepted
2018 Summary of Benefits H1777_2018SOB_Accepted SUMMARY OF BENEFITS January 1, 2018 - December 31, 2018 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
More informationMedical Associates Freedom Plan (Cost) Summary of Benefits January 1, 2018 December 31, 2018
(Cost) Summary of Benefits January 1, 2018 December 31, 2018 is a Medicare Cost plan with a Medicare contract. Enrollment in the Plan depends on contract renewal. The benefit information provided is a
More informationAllwell Medicare Plans Disenrollment Form
Allwell Medicare Plans Disenrollment Form If you request disenrollment, you must continue to get all medical care from Allwell until the effective date of disenrollment. Contact us to verify your disenrollment
More informationMedicare HMO Blue (HMO)
Benefits Overview 2017 Drug Copayments $10 $25 $45 Medicare HMO Blue (HMO) Medicare HMO Blue (HMO) is a Medicare Advantage plan from Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Blue Cross
More informationTake a Healthy Step. Wellness Resource Guide 2017
Take a Healthy Step Wellness Resource Guide 2017 Taking strides toward a healthy lifestyle November 2016 October 2017 Table of Contents Program outline... 2 What s new for 2017... 3 Step 1: MyHealth Questionnaire...4
More informationWellness for Life. July 1, 2017 June 30, University of Pittsburgh
Wellness for Life July 1, 2017 June 30, 2018 University of Pittsburgh Introduction to Wellness for Life Making healthy lifestyle changes isn t always easy, but it s important to have a goal and a plan
More informationCrisis Intervention Resources
Crisis Intervention Resources Warm Line The Recovery Support Warm Line is operated by Certified Peer Support Specialists between the hours of 9 a.m. and 10.p.m. seven (7) days a week, 365 days a year.
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans California Los Angeles H5087 Plan 001 1/1/2018 12/31/18 Easy Choice Freedom Plan (HMO SNP) H5087_WCM_03321E WellCare 2017 CA8RMRSOB03321E_0001 Summary
More informationMedical Associates Community Plan (Cost) Summary of Benefits January 1, 2018 December 31, 2018
(Cost) Summary of Benefits January 1, 2018 December 31, 2018 is a Medicare Cost plan with a Medicare contract. Enrollment in the Plan depends on contract renewal. The benefit information provided is a
More informationMedical Associates SmartPlan (Cost) Summary of Benefits January 1, 2018 December 31, 2018
(Cost) Summary of Benefits January 1, 2018 December 31, 2018 is a Medicare Cost plan with a Medicare contract. Enrollment in the Plan depends on contract renewal. The benefit information provided is a
More information2019 Summary of Benefits
2019 Summary of Benefits Medicare Advantage Plans North Carolina Buncombe, Durham, Henderson, Madison, McDowell, Orange, Person, Polk, Swain, Transylvania H0712 Plan 025 WellCare Access (HMO SNP) H0712_WCM_16188E_M
More informationAnnual Notice of Changes for 2019
Kaiser Permanente Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) offered by Kaiser Foundation Health Plan, Inc., Northern California Region Annual Notice of Changes for 2019 You are currently
More informationUpdated as of 11/1/ Individual & Family. Health Insurance
Updated as of 11/1/17 2018 Individual & Family Health Insurance 2018 Plan Options for Individuals and Families In-network benefits are described on the chart. For out-of-network benefits or more details,
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Florida Miami-Dade H1032 Plan 170 1/1/2018 12/31/18 WellCare Access (HMO SNP) H1032_WCM_03324E WellCare 2017 FL8WMRSOB03324E_0170 Summary of Benefits January
More informationYour health is in our plan.
Your health is in our plan. Presbyterian Health Plan has a long tradition of providing quality health care to State of New Mexico employees and their families. For 109 years, Presbyterian has been caring
More informationAuthorization to Disclose Protected Health Information (PHI)
Authorization to Disclose Protected Health Information (PHI) Notice to Member: Completing this form will allow Trillium Medicare Advantage to share your health information with the person or group that
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans New York Bronx, Kings, Nassau, New York, Queens, Richmond H3361 Plan 109 1/1/2018 12/31/18 WellCare Access (HMO SNP) H3361_WCM_03340E WellCare 2017 NY8NMRSOB03340E_0109
More informationAdvance Directives Information Sheet
What are Advance Directives? Advance Directives Information Sheet An Advance Health Care Directive (also known as an Advance Directive ) is a form that helps others give you the care you would want when
More informationFor Blue Cross NC members, fax form to
LIDOCAINE PATCH 5% (LIDODERM ) PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5-DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER NAME
More informationDRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM BENEFICIARY HANDBOOK
DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM BENEFICIARY HANDBOOK CITY AND COUNTY OF SAN FRANCISCO BEHAVIORAL HEALTH SERVICES (BHS) SUBSTANCE USE DISORDER SERVICES (SUD) Non-English Access to Service Free of
More informationNOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES Brain Injury Rehabilitation Specialists Long-Term Skilled Care for Youth and Younger Adults Post-Acute Inpatient Rehabilitation Outpatient Neuro Rehabilitation Supported Community
More informationSummary of Benefits Baptist Health Plan Advantage (HMO) Central Region
Summary of Benefits Baptist Health Plan Advantage (HMO) Central Region January 1, 2017 - December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
More information2018 Presbyterian Health Insurance Benefits for PNMR
2018 Presbyterian Health Insurance Benefits for PNMR phs.org/pnmr Improving the health of New Mexicans for over 100 years. Presbyterian Health Plan, Inc. has a long tradition of providing our members the
More informationbenefits Summary of FHCP s Medvantage Plan (HMO-POS) A Medicare Advantage HMO Plan Flagler, Volusia, and Seminole Counties
Summary of benefits FHCP s Medvantage Plan A Medicare Advantage HMO Plan Flagler, Volusia, and Seminole Counties H1035_NR770 (09/09/2016) H1035_NR531 FYI (08/17/2015) NOTES H1035_NR770 (09/09/2016) FHCP
More informationRequest for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because BlueCross BlueShield of South Carolina denied your request for coverage of (or payment for) a prescription drug, you have the right
More information2017 Schedule of Benefits Community Value (Silver)
In-Network Individual Deductible (Ded) $2,500 Family Deductible 1 $5,000 1 Under family coverage, once one Member of the family meets the Individual Deductible for the Calendar Year, remaining family members,
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Arkansas (AR), Mississippi (MS), South Carolina (SC), Tennessee (TN) H1416 Plan 027 1/1/2018 12/31/18 WellCare Advance (HMO-POS) H1416_WCM_03266E WellCare
More informationSUMMARY OF BENEFITS PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA HMO SNP - H4093, PLAN 001
SUMMARY OF BENEFITS PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA HMO SNP - H4093, PLAN 001 This is a summary of drug and health services covered by Provider Partners of Pennsylvania Health Plan (PPHP-PA)
More informationSummary of Benefits. Humana Gold Plus SNP-DE H (HMO SNP) Western North Carolina Western North Carolina Area
SBOSB038 2018 Summary of Benefits Humana Gold Plus SNP-DE H6622-027 (HMO SNP) Western North Carolina Western North Carolina Area Our service area includes the following county/counties in North Carolina:
More information2017 Summary of Benefits
Kaiser Permanente 2017 Summary of Benefits Kaiser Permanente Senior Advantage Medicare Medi-Cal South Plan (HMO SNP) Kaiser Foundation Health Plan, Inc. Southern California Region A nonprofit corporation
More information2018 Annual Notice of Changes
2018 Annual Notice of Changes AETNA BETTER HEALTH OF MICHIGAN (Medicare-Medicaid Plan) Aetna Better Health of Michigan, a MI Health Link plan (Medicare-Medicaid Plan), is a health plan that contracts with
More informationNotice Informing Individuals About Nondiscrimination and Accessibility Requirements
Notice Informing Individuals About Nondiscrimination and Accessibility Requirements DISCRIMINATION IS AGAINST THE LAW Hospice Austin & Austin Palliative Care complies with applicable Federal civil rights
More informationOver-the-counter medications
BlueNotes Over-the-counter medications Over-the-counter (OTC) and herbal medicines are medicines you can buy without a prescription from your doctor. These medicines may help you feel better by treating
More informationCialis (Tadalafil) PRIOR REVIEW/CERTIFICATION FAXBACK FORM
Cialis (Tadalafil) PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5-DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER NAME PRESCRIBER
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Florida Alachua, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, DeSoto, Duval, Escambia, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry,
More informationAdvance Directives Information Sheet
What are Advance Directives? Advance Directives Information Sheet An Advance Health Care Directive (also known as an Advance Directive ) is a form that helps others give you the care you would want when
More informationCompassionate community care.
Emergency department guide. On behalf of our team of physicians, nurses, volunteers and staff, welcome. We look forward to providing you with world class care. Compassionate community care. Compassionate
More informationc/o Clinical Review 1305 Corporate Center Dr., Building N10 Eagan, MN Request for Redetermination of Medicare Prescription Drug Denial
c/o Clinical Review 1305 Corporate Center Dr., Building N10 Eagan, MN 55121 Request for Redetermination of Medicare Prescription Drug Denial Because we Blue Cross Community MMAI (Medicare-Medicaid Plan)
More informationSummary of Benefits Provider Partners Maryland Advantage HMO SNP H8067, Plan 001
Summary of Benefits Provider Partners Maryland Advantage HMO SNP H8067, Plan 001 This is a summary of drug and health services covered by Provider Partners Health Plan HMO SNP January 1, 2018 December
More informationNeither Group Health Cooperative of South Central Wisconsin (GHC-SCW) nor its agents are connected with Medicare.
Group Health Cooperative of South Central Wisconsin 2017 MEDICARE SELECT OUTLINE OF COVERAGE The Wisconsin Insurance Commissioner has set standards for Medicare Select insurance. This policy meets these
More informationPeoples Health Secure Health (HMO SNP)
2018 SUMMARY OF BENEFITS Peoples Health Secure Health (HMO SNP) January 1, 2018 December 31, 2018 Peoples Health is a Medicare Advantage organization with a Medicare contract to offer HMO plans. Enrollment
More informationstudentbluenc.com/uncc
studentbluenc.com/uncc HEALTH PLAN FOR UNC CHARLOTTE STUDENTS 2017-2018 A HEALTHY PLAN for a successful future The UNC System has selected Student Blue to provide you with quality health insurance coverage
More informationSummary of Benefits. Community Care Family Care Partnership Program. (HMO SNP)(Community Care)
Summary of Benefits Community Care Family Care Partnership Program H2034, Plan 001 and H2034, Plan 002 (HMO SNP)(Community Care) This is a summary of drug, health and long-term care services covered by
More informationFINANCIAL ASSISTANCE APPLICATION
Belleville, IL HSHS St. Elizabeth s Hospital Breese, IL Decatur, IL HSHS St. Mary s Hospital Effingham, IL HSHS St. Anthony s Memorial Hospital Greenville, IL HSHS Holy Family Hospital Highland, IL Litchfield,
More informationSCAN Employer Group (HMO) is an HMO plan with a Medicare contract. Enrollment in SCAN Health Plan depends on contract renewal.
2017/2018 Summary of Benefits SCAN Employer Group - Newport-Mesa Unified School District (N-MUSD) (HMO) October 1, 2017 - September 30, 2018 SCAN Employer Group (HMO) is an HMO plan with a Medicare contract.
More informationFENTANYL: TRANSMUCOSAL (ABSTRAL ACTIQ, FENTORA ) INTRANASAL (LAZANDA ) SUBLINGUAL SPRAY (SUBSYS )
FENTANYL: TRANSMUCOSAL (ABSTRAL ACTIQ, FENTORA ) INTRANASAL (LAZANDA ) SUBLINGUAL SPRAY (SUBSYS ) PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE
More informationPRESCRIBER NAME PRESCRIBER NPI [REQUIRED] Blue Cross NC PROV ID # / TAX ID [out of state] CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX
Dry Eye Disease (keratoconjuctivitis) RESTASIS (cyclosporine ophthalmic emulsion 0.05%) Xiidra TM (lifitigrast ophthalmic solution 5%) PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY
More informationWELCOME... 1 GENERAL INFORMATION... 2 PAYMENT... 6 SERVICES... 13
rev 3-2018 Table of Contents WELCOME... 1 GENERAL INFORMATION... 2 A. MISSION...2 B. CORE VALUES...2 C. VISION...2 D. VISITATION...2 E. ACCESSIBILITY...2 F. SERVICE ANIMALS... 3 G. NONDISCRIMINATION POLICY...
More informationWelcome to Hillsboro Pediatric Clinic LLC PATIENT REGISTRATION FORM
Welcome to Hillsboro Pediatric Clinic LLC PATIENT REGISTRATION FORM Thank you for selecting us for your child s healthcare provider! In order to serve you, we need the following information. Please print.
More informationMercy Care Advantage (HMO SNP)
Mercy Care Advantage (HMO SNP) Mercy Care Advantage (HMO SNP) 2019 Summary of Benefits Mercy Care Advantage is an HMO SNP with a Medicare contract and a contract with the Arizona Medicaid Program. Enrollment
More informationMEMBER HANDBOOK IlliniCare Health (Medicare-Medicaid Plan)
2018 MEMBER HANDBOOK IlliniCare Health (Medicare-Medicaid Plan) H0281_18_ANOCMH2_Accepted_11212017 Language Services ATTENTION: If you do not speak English, language assistance services, free of charge,
More informationANNUAL NOTICE OF CHANGES FOR 2018
Blue Cross Community MMAI (Medicare-Medicaid Plan) SM ANNUAL NOTICE OF CHANGES FOR 2018 1-877-723-7702 (TTY/TDD: 711) We are available 24 hours a day, seven (7) days a week. The call is free. For more
More information2018 Summary of Benefits
2018 Summary of Benefits Health Net Seniority Plus Amber I (HMO SNP) Kern, Los Angeles, Orange, Riverside, San Bernardino, Fresno, San Diego, San Francisco, and Tulare Counties, CA H0562-055 Benefits effective
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Arkansas Arkansas, Ashley, Baxter, Bradley, Calhoun, Carroll, Chicot, Clark, Clay, Cleburne, Cleveland, Conway, Craighead, Crittenden, Cross, Dallas, Desha,
More informationMercy Care Advantage (HMO SNP) 2018 Summary of Benefits
Mercy Care Advantage (HMO SNP) 2018 Summary of Benefits Mercy Care Advantage (HMO SNP) is a Coordinated Care Plan with a Medicare contract and a contract with the Arizona Medicaid Program. Enrollment in
More informationPRE-OP INSTRUCTIONS. 5. Do not wear any make-up, nail polish, hairpins or jewelry to the surgery center. Do not bring money or valuables.
PRE-OP INSTRUCTIONS Please read these instructions and be sure to follow them carefully to avoid cancellation of your surgery: If you have any questions, feel free to call our office at 470-297-0257. Our
More informationWelcome to Molina Healthcare.
Welcome to Molina Healthcare. Your Extended Family. MolinaHealthcare.com New Mexico Member Handbook Centennial Care 2017 Molina Healthcare of New Mexico (Molina) complies with all Federal civil rights
More informationSummary of Benefits. Kaiser Permanente Senior Advantage Medicare Medicaid Plan (HMO SNP) January 1 December 31, 2018
January 1 December 31, 2018 2018 Summary of Benefits Kaiser Permanente Senior Advantage Medicare Medicaid Plan (HMO SNP) H0630_18010DB accepted PBPs 14 60613817 About this Summary of Benefits Thank you
More informationSummary of Benefits Care Wisconsin Partnership (HMO SNP) Contract H5209 Plan 002
Summary of Benefits Care Wisconsin Partnership (HMO SNP) Contract H5209 Plan 002 This is a summary of drug, health and long-term care services covered by Care Wisconsin Partnership (HMO SNP). Partnership
More information2016/2017. Summary of Benefits
2016/2017 Summary of Benefits Nondiscrimination Notice UPMC Health Plan 1 complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age,
More informationREQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax:
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: PO Box 66571 St. Louis, MO 63166 Fax Number: 1-888-235-8551 You may also ask us for a
More informationMarin County Drug/Medi-Cal Organized Delivery System (DMC-ODS) Beneficiary Booklet
Marin County Drug/Medi-Cal Organized Delivery System (DMC-ODS) Beneficiary Booklet 9/2017 1 P a g e Spanish (Español) - ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia
More informationRequest for Redetermination of Medicare Prescription Drug Denial
Request for Redetermination of Medicare Prescription Drug Denial Because we BlueRx (PDP) denied your request for coverage of (or payment for) a prescription drug, you have the right to ask us for a redetermination
More informationMarin County Drug/Medi-Cal Organized Delivery System (DMC-ODS) Beneficiary Booklet
Marin County Drug/Medi-Cal Organized Delivery System (DMC-ODS) Beneficiary Booklet 3/2017 1 P a g e Spanish (Español) - ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia
More informationSummary of Benefits. SCAN Connections at Home (HMO SNP) Los Angeles, Riverside and San Bernardino Counties. January 1, December 31, 2018
2018 Summary of Benefits Connections at Home (HMO SNP) Los Angeles, Riverside and San Bernardino Counties January 1, 2018 - December 31, 2018 Connections at Home (HMO SNP) is an HMO plan with a Medicare
More information2018 Medicare Advantage PPO
2018 Medicare Advantage PPO a Medicare Advantage plan from Blue Cross Blue Shield of Michigan Alabama, Florida and Indiana Medicare Plus Blue SM is a PPO plan with a Medicare contract. Enrollment in Medicare
More information2018 Summary of Benefits
2018 Summary of Benefits Medicare Advantage Plans Tennessee Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett,
More informationY0114_17_27850_U_093 CMS Accepted 10/01/ MUSENMUB_093 H5817_ _TX-HMO-SNP Amerivantage Dual Coordination (HMO SNP) 1
Summary of Benefits for Amerivantage Dual Coordination (HMO SNP) Available in: Select Counties* in Texas *See Page 2 for a list of counties. Plan year: January 1, 2017 December 31, 2017 In this section,
More informationEnrollee Handbook. Broward, Miami-Dade and Monroe Counties. Effective March 1, 2017
Enrollee Handbook Broward, Miami-Dade and Monroe Counties Effective March 1, 2017 PHC Florida is a Managed Care Plan with a Florida Medicaid contract. AHCA 022317 PHC MMA Form 14.5 Discrimination Is Against
More informationMANAGED LONG TERM CARE PLAN MEMBER HANDBOOK
MANAGED LONG TERM CARE PLAN MEMBER HANDBOOK 1-866-263-9083 www.archcare.org i WELCOME TO ARCHCARE COMMUNITY LIFE We are pleased to provide you with your ArchCare Community Life Member Handbook. The Handbook
More informationINDIVIDUAL ENROLLMENT REQUEST FORM
INDIVIDUAL ENROLLMENT REQUEST FORM If you need assistance with this form, contact us: OHIO MEDICAID CONSUMER HOTLINE: (800) 324-8680 Monday - Friday: 7 a.m. to 8 p.m. and Saturday : 8 a.m. to 5 p.m. www.ohiomh.com
More informationSpring 2018 Health and Wellness Newsletter
Spring 2018 Health and Wellness Newsletter In This Issue Health Care Fraud, Waste and Abuse...1 Protecting Your Privacy... 1-3 Health Education...3 Vendor Transitions for Dental, Vision and Transportation...
More information2017 Member Handbook. A Guide to Your BCBSNM Managed Care Plan NTENNIALCARE ADMINISTERED BY:
2017 Member Handbook A Guide to Your BCBSNM Managed Care Plan ADMINISTERED BY: NTENNIALCARE Dear Blue Cross Community Centennial Care Member, Welcome to the Centennial Care Managed Health Care Program,
More information2018 Sharp Direct Advantage Medicare Enrollment Kit
2018 Medicare Enrollment Kit SM e the best. iegans deserv e believe San D W and Plans for Medicare-Eligible Individuals Residing in San Diego County The basics of Medicare Have questions? We have answers!
More information2018 Provider Directory Urgent Care Centers.
2018 Provider Directory Urgent Care Centers www.amerihealthcaritasla.com URGENT CARE 867 URGENT CARE ACADIA PARISH, LA XPRESSMED URGENT CARE OF CROWLEY LLC 753 ODD FELLOWS RD STE F CROWLEY, LA 70526 (337)
More informationSummary of Benefits. SCAN Connections (HMO SNP) Los Angeles, Riverside and San Bernardino Counties. January 1, December 31, 2019
2019 Summary of Benefits SCAN Connections (HMO SNP) Los Angeles, Riverside and San Bernardino Counties January 1, 2019 - December 31, 2019 SCAN Connections (HMO SNP) is an HMO plan with a Medicare contract
More informationYour Benefit Summary Connect 7350 Bronze
Your Benefit Summary Connect 7350 Bronze Providence Connect Network Individual Calendar Year Deductible (family amount is 2 times individual) Individual Out-of-Pocket Maximum (family amount is 2 times
More informationYour Journey. to a Healthier Heart
Your Journey to a Healthier Heart Our goal is to put you at ease by answering any questions and addressing any concerns you may have. Thank you for choosing the world-class care at Sanger Heart & Vascular
More informationAffordable Care Act Section 1557 Nondiscrimination Policy
Affordable Care Act Section 1557 Nondiscrimination Policy 1. Nondiscrimination Notice and Accessibility Requirements. [Astoria Skilled Nursing and Rehabilitation] will take reasonable steps to ensure that
More informationSummary of Benefits. Allwell Dual Medicare (HMO SNP)
2018 Summary of Benefits Allwell Dual Medicare (HMO SNP) Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland counties,
More information2018 Benefit Highlights
Orange County 2018 Benefit Highlights SCAN Plus (HMO) Medicare Advantage Plan What Are Additional Benefits and Services? Additional Benefits are benefits and services not offered by Original Medicare.
More informationMEDICAID MANAGED CARE ENROLLMENT NOTICE
OHIO DEPARTMENT OF MEDICAID OHIO MEDICAID CONSUMER HOTLINE 505 SOUTH HIGH STREET COLUMBUS OH 43215 If you need assistance with this letter, contact us. Ohio Medicaid Consumer Hotline: (800) 324-8680 Monday
More informationHIV/Aids Waiver. Effective January. IL_BCCHP_ENR_WBHIV8 Approved
HIV/Aids Waiver Effective January 2018 IL_BCCHP_ENR_WBHIV8 Approved 12202017 WHEN YOU NEED TO CONTACT MEMBER SERVICES Our goal is to serve your health care needs through all of life s changes. If you
More informationTo best serve your needs and enhance your visit, we have enclosed paperwork for you to review and complete prior to your first appointment:
Welcome and thank you for selecting InterMed as your health care provider. Choosing a physician is an important decision and we are honored that you have entrusted your care to us. InterMed takes great
More information2018 Benefit Highlights
Los Angeles, Riverside and San Bernardino Counties 2018 Benefit Highlights SCAN Connections (HMO SNP) Medicare Advantage Plan The SCAN Story SCAN, a not-for-profit health plan, was founded in 1977 by seniors,
More informationSUMMARY OF BENEFITS. Kalos Health Gold Plus HMO-SNP H
2424 Niagara Falls Blvd. Niagara Falls, NY 14304 1-800-399-1954 (TTY 711) www.kaloshealth.org SUMMARY OF BENEFITS Kalos Health Gold Plus HMO-SNP H3227-001 This is a summary of drug and health services
More informationDrug Medi-Cal Organized Delivery System Beneficiary Handbook
Drug Medi-Cal Organized Delivery System Beneficiary Handbook Substance Use Disorder Services Behavioral Health Division Health Services Agency County of Santa Cruz 2018 County of Santa Cruz Beneficiary
More informationThe Regence Personalized Care Support Program
The Regence Personalized Care Support Program Sensitive and personal palliative care for those facing serious illness or injury Health care that s patient-centered, family-oriented and compassionate is
More information