2018 Medicaid Member Handbook and Welcome Kit

Size: px
Start display at page:

Download "2018 Medicaid Member Handbook and Welcome Kit"

Transcription

1 FLORIDA 2018 Medicaid Member Handbook and Welcome Kit MAGELLAN COMPLETE CARE

2 Table of Contents Introduction and First Steps About Magellan Complete Care SM...4 Welcome to Magellan Complete Care!....4 Please Call Today!...4 Your Care Coordination Team...5 Helpful Tips...5 Contact Information...6 After-Hours...6 Enrollment Becoming a Member...8 Open Enrollment...8 Pregnancy and Newborn Enrollment...8 Member ID Card...9 Enrollment & Disenrollment...9 Reinstatement Process...10 How to Get Services...11 Selecting a PCP...11 Changing a PCP...11 Access to Care/Appointment...11 Continuity of Care...12 Transportation...12 Referral and Approval for Specialty, Ancillary and Hospital Care...12 Access to Behavioral Health Services Getting Behavioral Health & Substance Abuse Services...14 In Lieu of Services...14 Emergency Services...15 Behavioral Health Emergencies...15 Did you seek care for an emergency?...15 Out of Area Emergency Services...15 Covered Services...16 Covered Service and Limitations...16 Expanded Services...21 Additional Notes for Covered Services...22 Fees for Members Living in Residential Facilities...24 Services Not Covered by Magellan Complete Care...24 How to Get Medications...25 Specialty Medications...25 Informed Consent for Certain Drugs Improving Your Health...26 Member Rewards Program...26 Prevention Programs...26 Case Management and Disease Management Programs...26 Online Interactive Tools For Health and Wellness...27 Child Health Check-Up/Vaccines...27 Quality Benefit Enhancement Programs...27 Review of New Treatment Options...28 Urgent Care...28 Complaints, Grievances and Appeals Process...29 Complaints...29 Grievances...29 Appeals...30 Expedited Appeal...30 Medicaid Fair Hearing/ Subscriber Assistance Program...30 Protected Health Information...32 Release of Information on Sensitive Conditions...32 Member Rights and Responsibilities...33 Second Medical Opinion...34 Reporting Abuse, Neglect, or Exploitation...34 Reporting Fraud, Waste, and Abuse...34 Living Wills and Advance Directives...36 Helpful Forms...41 Adult Health Assessment...43 Child Health Assessment...47 Grievance Form...51 Appeals Form...53 Living Will...55 Designation of Health Care Surrogate...57 Designation of Health Care Surrogate for Minor...59 Uniform Donor Form...61 Health Care Advance Directives

3 Introduction and First Steps About Magellan Complete Care SM Magellan Complete Care has a lot of know-how in health care. We help our members with these services: Coordinating medical care with your doctors. Coordinating behavioral health services with medical care. Giving you the okay for specialty and hospital services. Quality management programs. Case management and disease management programs for members with special needs and conditions. Managing your pharmacy benefits. To join Magellan Complete Care you must have Medicaid benefits and a Serious Mental Illness (SMI). Our plan specializes in linking your physical and behavioral health care. We make sure your care is coordinated and you have whole health care. If you would like to learn more about Magellan Complete Care, please visit our website at You will be able to learn about our health plan. Learn about quality programs, healthy living programs, physician incentive programs and health education resources. You can also find performance measures and information about our plan s performance. Magellan Complete Care is a Managed Care Plan with a Florida Medicaid contract. The Florida Agency for Healthcare Administration (AHCA) oversees our plan. They have information on their website at Welcome to Magellan Complete Care! We are happy you are our member. Your Member Handbook has important information. This handbook will help you better understand your health plan. This is also your certificate of coverage. If you need the Member Handbook in a different language, please call Magellan Complete Care s Customer Service at (TTY: ). This service is available free of charge. Si necesita el manual de miembro en otro idioma, por favor llame a Magellan Complete Care. Llame al (TTY: ). We will help you with important steps to stay healthy! Please Call Today! Call Magellan Complete Care Member Services at or TTY only and our Member Specialists will: Welcome you to Magellan Complete Care and answer your questions. If you have not chosen a primary care doctor (PCP), we will help you choose one over the phone. Help you schedule an appointment with your PCP. Help you visit your PCP within the first 30 days of enrollment to get a health assessment. Tell you about extra benefits. Tell you about special programs. 4

4 It will only take a few minutes. It will help us to serve you better. If we don t hear from you, we will try to call you to make it easier for you. We want to do everything we can to help you stay healthy. Your Care Coordination Team Magellan Complete Care will connect you to your personal Health Guide who will help you: Find your way through the health care system. Make sure all of your doctors have a copy of your medical records. Help you with making appointments. Help you complete your health and wellness questionnaire. Connect to support services in your community. We will work with you to choose a primary care doctor and primary behavioral health doctor. They will be part of your Care Coordination Team. Your team will also include you, your family or supports and others such as a case manager, as needed. Please let us know if someone on your Care Coordination Team is not a good fit. You can choose a different Health Guide, Integrated Care Case Manager and/or Wellness Specialist within Magellan Complete Care, if one is available. Helpful Tips Before you go to your first primary care doctor (PCP) appointment, you may want to write down important information to share with him/her. Behavioral health provider name (if seeing one). Other specialists names. Your health conditions (for example, bipolar disorder, heart disease, asthma). Medications and how much you take. Questions or concerns you have about your health. Please keep a copy of these documents handy: Member ID card. Member Handbook. Provider Directory. You will need these documents as a member of our health plan. If you need help with anything about your health or health plan, please call Customer Service toll free at If you are hearing impaired, call our TTY number at We are able to talk with you in any language or format. This service is free of charge. We are here for you 24 hours a day, seven days a week. If you have health questions, our Nurse Line is here for you. If you have an emergency such as chest pain or trouble breathing, call 911 instead of the Nurse Line. If your address changes, please contact us at and the State Medicaid Enrollment Broker to update your address. You must also contact the Florida Department of Children and Families and tell them about your address change. 5

5 Contact Information We want to hear from you. You are not alone. Just give us a call for help. Magellan Complete Care s telephone numbers are toll free. We can answer your questions in any language. We can help you if you are hearing or vision impaired too. These services are free of charge. Customer Service is available from 8:00 am 7:00 pm at If you are hearing impaired, call our TTY number toll free at Nurses are available 24/7 to help with nonemergency health questions at If you are hearing impaired, call our TTY number toll free at Please visit our website at After-Hours Our phone lines are staffed with nurses and nonclinical staff who can help you get the information and services that you need after normal business hours. After-Hours staff are here for you from 7:00pm- 8:00am on weeknights. During the weekends, they are there on Friday from 7:00pm -8:00am Monday morning. Our After-Hours staff can help with many member and provider requests. They can help members who have questions about medicine side effects, drugs that may effect another drug, and if generic drug choices are offered. After-hours staff can also help members in crisis or with urgent or emergency clinical questions and give advice over the phone. These telephone numbers may also help you: Florida Department of Children and Families Hours: 8:00 am to 5:00 pm Toll free: State Medicaid Enrollment Broker Toll free: TTY/TDD: Web: Local Medicaid office Bay, Franklin, Gulf, Holmes, Jackson, and Washington Counties Office: Toll free: Local Medicaid office Calhoun, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla Counties Office: Toll free: Local Medicaid office Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia Counties Office: Toll free: Local Medicaid office Pasco and Pinellas Office: Toll free: Local Medicaid office Hardee, Highlands, Hillsborough, Manatee, and Polk Counties Office: Toll free: Local Medicaid office Brevard, Orange, Osceola, and Seminole Counties Office: Toll free:

6 Local Medicaid office Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie Counties Office: Toll free: Local Medicaid office Broward County Office: Toll free: Local Medicaid office Miami-Dade and Monroe Counties Office: Toll free: Aging and Disabilities Resource Centers Hours: 8:00 am 5:00 pm Toll free: (ELDER)-5337 TDD: Web: Area 2 Agency Area Agency on Aging for North Florida, Inc Mahan Drive Tallahassee, FL, Office: Web: Area 4 Agency ElderSource, The Area Agency on Aging of Northeast Florida Old St Augustine Road Jacksonville, FL Office: Web: Area 5 Agency Area Agency on Aging of Pasco-Pinellas, Inc Kroger Boulevard North, Suite 100 St. Petersburg, FL Office: Web: Area 6 Agency West Central Florida Area Agency on Aging, Inc Breckenridge Parkway, Suite F Tampa, FL Office: Web: Area 7 Agency Senior Resource Alliance 988 Woodcock Road, Suite 200 Orlando, FL Office: Web: Area 9 Agency Your Aging Resource Center 4400 N. Congress Avenue West Palm Beach, FL Office: Web: Area 10 Agency Aging & Disability Resource Center of Broward County, Inc Hiatus Road Sunrise, FL Office: Web: Area 11 Agency Alliance for Aging, Inc. 760 NW 107th Avenue, Suite 214, 2nd floor Miami, FL Office: Web: 7

7 Enrollment Becoming a Member To join Magellan Complete Care, you must have Medicaid benefits and a serious mental illness (SMI). Eligibility is managed by the Florida Department of Children and Families (DCF) at ACCESS ( ). Membership begins on the first day of any calendar month once you are approved by the State. You have the right to choose a health plan. If you don t choose a health plan, the State will choose one for you. Enrollment If you are a mandatory enrollee required to enroll in a plan, once you are enrolled in Magellan Complete Care or the State enrolls you in a health plan, you will have 120 days from the date of your first enrollment to try the Managed Care Plan. During the first 120 days, you can change plans for any reason. After the 120 days, if you are still eligible for Medicaid, you will be enrolled in the plan for the next eight months. This is called lock-in. Open Enrollment If you are a mandatory enrollee, the State will send you a letter 60 days before the end of your enrollment year telling you that you can change plans if you want to. This is called open enrollment. You do not have to change Managed Care Plans. If you choose to change plans during open enrollment, you will begin in the new plan at the end of your current enrollment year. Whether you pick a new plan or stay in the same plan, you will be locked into that plan for the next 12 months. Every year you can change Managed Care Plans during your 60 day open enrollment period without cause. Some Medicaid recipients are voluntary enrollees and can change health plans whenever they choose, for any reason. For example, people who reside in residential community facilities operated through DJJ or mental health treatment facilities can change plans at any time for any reason. To find out if you may change plans, call the Enrollment Broker: Enrollment Broker / Choice Counseling Hours: Mon Thurs 8:00 am to 8:00 pm Fri 8:00 am to 7:00 pm Sat 9:00 am to 1:00 pm Toll free: TTY/TDD: Web: Pregnancy and Newborn Enrollment Getting medical care during pregnancy is an important step in making sure that you and your baby are healthy. We will ask you if you are pregnant when you join the plan. You can call us at any time to let us know if you become pregnant. Magellan Complete Care would like to help you get the care you need during your pregnancy. You must call the Florida Department of Children and Families (DCF) to enroll your baby in Medicaid. They will provide you with your baby s Medicaid number. You may also call Medicaid Options for assistance in choosing a plan for your baby. Their toll free number is (TTY/TDD ). 8

8 Member ID Card Here is a picture of a sample Member ID card. Please keep your card with you at all times and take it with you to your doctor visits. English ID Card front: back: Member Name: xxxmembernamexxx Member #: xxmembernbr-xx Group: xxxxx Enrollment Date: xx/xx/xxxx Utilize Medicaid Participating Pharmacies BIN #: PCN #: 622 RxGroup: XXXXXXX P.O. Box Miami, FL MagellanCompleteCareofFL.com Customer Service, Claims/Billing, and Transportation: (Monday Friday 8 a.m. 7 p.m. EST) If you are hearing impaired, call our TTY number at Emergency Services: Seek treatment at the nearest emergency room or urgent care center or call 911. Notify your doctor and the health plan within 48 hours or as soon as possible if you are admitted to the hospital. Authorizations/Eligibility (Participating and Non-Participating Providers): Mail Claims to: Payor ID#: Magellan Complete Care PO Box 2097 Maryland Heights, MO Possession of an ID card does not guarantee eligibility or payment for services provided. If you lose your card, please call Customer Service toll free at If you are hearing impaired, call our TTY number toll free at Magellan Complete Care will send you a new card. Enrollment & Disenrollment Some Medicaid recipients may change Managed Care Plans whenever they choose, for any reason. To find out if you may change plans, call the Enrollment Broker If you are a mandatory enrollee required to enroll in a plan, once you are enrolled in Magellan Complete Care or the State enrolls you in a plan, you will have 120 days from the date of your first enrollment to try the Managed Care Plan. During the first 120 days you can change Managed Care Plans for any reason. After the 120 days, if you are still eligible for Medicaid, you will be enrolled in the plan for the next eight months. This is called lock-in. If you are a mandatory enrollee, the State will send you a letter 60 days before the end of your enrollment year telling you that you can change plans if you want to. This is called open enrollment. You do not have to change Managed Care Plans. If you choose to change plans during open enrollment, you will begin in the new plan at the end of your current enrollment year. Whether you pick a new plan or stay in the same plan, you will be locked into that plan for the next 12 months. Every year you may change Managed Care Plans during your 60 day open enrollment period without cause. 9

9 If you are a mandatory enrollee and you want to change plans after the initial 120-day period ends or after your open enrollment period ends, you must have a state-approved, good cause reason to change plans. The following are state-approved cause reasons to change Managed Care Plans: 1. The enrollee moves out of the region, or the enrollee s address is incorrect, and the enrollee does not live in a county where the Managed Care Plan is authorized to provide services. 2. The provider is no longer with the Managed Care Plan. 3. The enrollee is excluded from enrollment. 4. A substantiated marketing violation has occurred. 5. The enrollee is prevented from participating in the development of his/her treatment plan/ plan of care. 6. The enrollee has an active relationship with a provider who is not on the Managed Care Plan s panel, but is on the panel of another health plan. 7. The enrollee is in the wrong Managed Care Plan as determined by the Agency. 8. The Managed Care Plan no longer participates in the region. 9. The state has imposed intermediate sanctions upon the Managed Care Plan, as specified in 42 CFR (a) (3). 10. The enrollee needs related services to be performed concurrently, but not all related services are available within the Managed Care Plan s network, or the enrollee s PCP has determined that receiving the services separately would subject the enrollee to unnecessary risk. 11. The Managed Care Plan does not, because of moral or religious objections, cover the service you seek. 12. The enrollee missed open enrollment due to a temporary loss of eligibility. 13. Other reasons per 42 CFR (d) (2), including, but not limited to, poor quality of care; lack of access to services covered under the contract; inordinate or inappropriate changes of PCPs; service access impairments due to significant changes in the geographic location of services; an unreasonable delay or denial of service; lack of access to providers experienced in dealing with the enrollee s health care needs; or fraudulent enrollment. 14. To find out if you can change plans, call the State Medicaid Enrollment Broker, toll free: Reinstatement Process Keeping your Medicaid benefits is critical. We do not want you to lose them. Here are a few things to remember: Contact your Enrollment Broker / Choice Counselors, toll free at Get your case status. Respond to all requested paperwork. Keep all scheduled appointments. If you miss an appointment, call and reschedule immediately. We can help you with transportation to your appointment, if needed. If you lose your Medicaid benefits, you can no longer be part of our plan. However, if you get your benefits back within 180 days, you will automatically be with Magellan Complete Care again. When you return, you will have the same PCP unless: The PCP is no longer available. You live in a different area. You choose another PCP. 10

10 How to Get Services Selecting a PCP Your primary care doctor (PCP) is your personal doctor who will manage all of your health care. You have the right to choose any PCP that is part of Magellan Complete Care. We have many PCPs to choose from. Please refer to your Provider Directory, our website or call us at If you are hearing impaired, call our TTY number toll free at We can mail you a new Provider Directory if you need one. If you do not choose a PCP, Magellan Complete Care will choose one for you. You may choose to have your whole family with the same PCP. You can choose a different PCP based on each family member s needs. A female member may choose an obstetrician/ gynecologist (OB/GYN) as her PCP if the OB/GYN agrees to serve as the PCP. Please call us at or TTY only, if you would like to choose an OB/GYN as your PCP. We will work with you to choose a PCP for your baby before the baby is born. The name and telephone number of your PCP can be found on: Your Welcome Letter. Provider Directory. Magellan Complete Care s website at If you would like additional information about a doctor, like their professional qualifications, please call Customer Service. Professional qualifications include medical school attended, where your doctor did their residency after medical school, and board certification. Changing a PCP If you want to change your PCP, please call Customer Service toll free at If you are hearing impaired, call our TTY number toll free at Access to Care/Appointment You deserve the right to care. Providers in our network must make an appointment: Right away, if an emergency. In one day, if Urgent Care. In one week, if routine Sick Patient Care. In one month, if Well Care Visit. If Magellan Complete Care cannot give you a needed and covered service by a provider in our network, we will cover these services by an outof-network provider well and timely. The services will be covered as long as Magellan Complete Care does not have a provider in network to give you the services. Don t forget to bring your Member ID card to each visit. Some new members will need help making the change from their old health plan to their new one. We will ask you about appointments and treatment you were receiving before you joined Magellan Complete Care. We will help you make the change. Once you have a Magellan Complete Care doctor, your doctor should see you within one hour of your appointment time. Your primary care doctor (PCP) is ready to help you 24 hours a day and seven days a week. If you call at night or on the weekend, you will be told how to reach your doctor. 11

11 Continuity of Care Magellan Complete Care will make sure that you keep getting the care your doctors give you today. For your first 60 calendar days with our plan, your doctor does not have to get an okay from us. Please call us if you have any questions or need any help with your appointments. After the 60 days pass, if you wish to see a doctor that is not in the Provider Directory your PCP can contact us for an okay. We can also help you schedule a visit, tell your previous provider, and move your health records to your new provider. We can also help you with transportation to your appointment. Transportation Magellan Complete Care offers transportation to and from your covered medical and dental appointments. Medicaid-eligible, non-emergency medical transportation services are offered by Veyo. To schedule a ride, please call at least 3 business days (72 hours) before you need to be picked up. When you call to schedule transportation, please have the info below: Your first and last name Your member ID number Your home address where we will pick you up Your telephone number to contact you The name, address, and phone number of the healthcare facility Your appointment time The type of provider you are seeing (physician, laboratory, etc.) If this will be an appointment you will go to again in the future Members that need special items (e.g. a car seat) must provide these items. Please let the agent know when you schedule your trip. Written parental consent is required for all members traveling alone at the ages of All members under the age of 15 must travel with an adult 18 years and older regardless if the parent gives their written consent. If you need extra help during your trip, please let the agents know. If you need to cancel or reschedule your trip, or if your ride is late to pick you up, please call for help. Please Note: Call 911 if you have an emergency and need to be taken to the hospital. Referral and Approval for Specialty, Ancillary and Hospital Care If you need to see a specialty doctor, you need an okay from your primary care doctor (PCP). Most other services need an okay from your primary care doctor (PCP) and Magellan Complete Care. We have a team of nurses and behavioral health clinicians to review your doctor s ask for an okay. They use notes from your doctor and a set of guides to decide if the service is medically necessary for you. Many health plans use the same guides. Call us at or TTY only, if you need more information. We can help you with getting a referral or if you want details on how we decide to okay your service. If we do not give your doctor an okay, we will send you and your doctor a letter and tell you how you can appeal. 12

12 Decisions for approved services are based on making sure the service is what you need; and that it is a covered benefit. We do not reward or encourage staff to make decisions that result in less care than you need. We also do not reward doctors or others for issuing denials for services. These services do not require prior approval: Emergency services and crisis stabilization. Post stabilization services or other post stabilization care. Some chiropractic services at a participating provider. Optometrist annual exam at a participating provider. Some podiatric services at a participating provider. Dermatology services up to 5-times per year with no referral at a participating provider. Family planning services; these may be obtained from any participating Medicaid provider. Gynecology services including annual well woman exam and follow-up care as a result of the exam at a participating provider. Diagnosis and treatment of sexually transmitted disease when provided at the County Health Department. Routine outpatient behavioral health services such as evaluations, medication management, individual and/or family therapy. Your Provider Directory lists doctors and hospitals that are part of our network. If you wish to see a doctor not in the Provider Directory, not in our network, your primary care doctor (PCP) can contact us for an okay and to let us know about your needs. We will only give the okay to see a doctor that is out of network when the type of doctor you need is not available in the Magellan Complete Care network. Normally, we do not pay for out-of-network care except emergency care and family planning services. You may be able to see a specialty doctor without getting an okay each time. This is a standing referral for when you have a long-term illness. Your PCP will contact us to arrange this. Access to Behavioral Health Services Taking care of your Behavioral Health condition is very important. To maintain good health and wellbeing Magellan Complete Care wants to make sure that you have the right care when you need it. We are here to support you in your recovery process. If you feel like you are having the following feelings or problems or they are getting worse, you may need to see your Behavioral Health provider right away: Constantly feeling sad. Feeling hopeless or helpless. Feelings of guilt. Feeling of worthlessness. Difficulty sleeping. Poor appetite. Weight loss. Loss of interest. Difficulty concentrating. Irritability. Constant pain such as headaches, stomach and back aches. We are here to help you make sure that you get the behavioral health care you need to feel better. Your Health Guide and our Nurses available through the Nurse Line, can help you make appointments to make sure you see your provider quickly. If you need help with an urgent or emergency appointment please call us at or if you are hearing impaired please dial our TTY number

13 Getting Behavioral Health & Substance Abuse Services You can get help in finding a behavioral health provider by calling If you are hearing impaired, call our TTY number toll free at You can also look in our Provider Directory or you can look on our website at Someone is available to help you 24 hours a day and seven days a week. If you call, you will be given the names of a number of providers in your local area. You can choose to call one for an appointment. You do not need to call your primary care doctor (PCP) for a referral for behavioral health appointments. Some services do require an okay from us. Your provider will ask for an okay when it is needed. Behavioral health and substance abuse services you can get include inpatient and outpatient hospital services and psychiatric doctor services. You can also get a wide range of behavioral health services. Sometimes you can get these services in the community, in your home, or in schools. Some of the behavioral health services you may seek for you or a family member include: Individual, family, and group therapy. Day treatment for adults and children. Individual and family assessments. Evaluations. Treatment planning. Psychosocial rehabilitation. Targeted case management. Therapeutic behavioral on-site services for children and adolescents. If you want to change to a different provider or request help in finding a second opinion, we are available to assist you. Call Magellan Complete Care at If you are hearing impaired, call our TTY number toll free at In Lieu of Services Magellan Complete Care offers replacement services or In Lieu of Services to our members. This is decided by the Agency for HealthCare Administration. These services are: Crisis Stabilization Units may be used for up to fifteen (15) days in a month instead of inpatient psychiatric hospital care. Detoxification or addiction receiving services may be used for up to fifteen (15) days in a month instead of inpatient detoxification hospital care. Mobile Crisis assessment and Intervention for members in the community. Ambulatory Detoxification services may be given instead of inpatient detoxification hospital care when medically needed. Self-Help/Peer Services. Adult In-Home Therapy. Behavioral Health Partial Hospitalization treatment (BH PHP) Behavioral Health Intensive outpatient treatment (BH IOP) Substance Abuse Partial Hospitalization (SA PHP). 14

14 Emergency Services Emergency Services An emergency is when you have severe pain, illness, behavioral health crisis or injury that could result in danger to you or your unborn child. Call 911 right away. In an emergency, you have the right to choose any hospital or other medical setting. You do not need to get approval from your PCP or Magellan Complete Care for emergency care. Behavioral Health Emergencies First, decide if you are having a behavioral health emergency. Do you think that you are a danger to yourself or others? If so, call 911 or go the nearest emergency room for help if you think you are in danger. Follow these steps even if the emergency room is not in our service area. If you need help right away or have a behavioral health emergency outside the plan s service area, call 911. Please Let Us Know Once you are in a safe place, please let us know or ask someone to let us know by calling the number on your ID card. You should also call your Health Guide. We will call your PCP or regular behavioral health provider. For out-of-area emergency care, when you are stable, we will help with plans to move you to in-network care when possible. Did you seek care for an emergency? If you go to the hospital for an emergency, you need to make sure you get care after the emergency event, called Post Stabilization services. This may help to keep you from having another behavioral health emergency. Post- Stabilization services are covered services you get after emergency room care within or outside the Provider Network. These are services delivered to keep your condition stable after an emergency. Post-stabilization care services are provided and covered without asking for an okay. Once you leave the hospital: It is important to follow-up with your doctor within twenty-four (24) to forty-eight (48) hours. You should schedule a visit to see a behavioral health provider for follow-up care. We can help you make this appointment and schedule transportation, if needed. We recommend you get an appointment before you leave the hospital. Please call us or TTY only, if you need help making an appointment. Out of Area Emergency Services If you are out of the service area, please get help from the nearest urgent care center or hospital. Please call us or TTY when you are out of the service area and have required urgent or emergency services. We would like to make sure that we are able to help you get the care you need. 15

15 Covered Services Covered Service and Limitations Magellan Complete Care covers Medicaid-covered services as specified in the contract with the State of Florida Agency for Health Care Administration. You are limited to how often you use some of these services and there are differences for adults and children. Please call us at or for hearing impaired TTY, if you have questions about benefit limits. Your Health Guide can also assist you. Magellan Complete Care has no co-pays for covered services. You do not have to pay money for any covered service if you visit a network provider. The following is a summary of the services that are covered by Magellan Complete Care. Magellan Complete Care must provide all medically necessary services for its members who are under age 21. This is the law. This is true even if Magellan Complete Care does not cover a service or the service has a limit. As long as your child s services are medically necessary, services have: No dollar limits; or No time limits, like hourly or daily limits Your provider may need to ask Magellan Complete Care for approval before giving your child the service. Call or for hearing impaired TTY, if you want to know how to ask for these services. Service Adult Basic Dental Services Child Health Check Up (CHCUP)/EPSDT Description Full dental services for all enrollees age 20 and below. Medically necessary oral and maxillofacial surgery for all eligible Medicaid recipients regardless of age. Emergency dental services to enrollees age 21 and older, and denture and denture-related services. Medicallynecessary, emergency dental procedures to alleviate pain or infection to enrollees age 21 and older. Emergency dental care for enrollees 21 years of age and older is limited to a problem focused oral evaluation, necessary radiographs in order to make a diagnosis, extractions, and incision and drainage of an abscess. Full and removable partial dentures and denture-related services are also covered services for enrollees 21 years of age and older. For children, CHCUP includes comprehensive health and developmental history, unclothed physical examination, developmental assessment, nutritional assessment, appropriate immunizations, laboratory testing, health education, dental screening, vision screening, hearing screening, diagnosis and treatment and referral and follow-up as appropriate. 16

16 Service Diabetes Supplies and Education Emergency Services Family Planning Services Freestanding Dialysis Facility Services Hearing Services Durable Medical Equipment Home Health Care Services and Durable Medical Equipment Description Coverage for medically appropriate and necessary equipment, supplies, and services used to treat diabetes. This includes outpatient self-management training and educational services. Includes emergency medical care 24 hours a day, 7 days a week. You do not need approval from Magellan Complete Care, nor your PCP to go to the emergency room if you are having a medical situation. Family Planning Services includes information, referral education, counseling, diagnostic procedures and contraceptive drugs and supplies. Services are voluntary and you are permitted full freedom of choice of methods for Family Planning to help you plan a family size or help you space the time between having children. You can go to any provider that participates with Medicaid for these services without a referral from your PCP. Includes routine laboratory tests, dialysis-related supplies, ancillary and other items. Services include all services and procedures rendered by a participating provider when needed for preventive, diagnostic, therapeutic, or to treat a particular injury, illness or disease. Hearing Services include examinations and evaluations necessary for the furnishing of one standard hearing aid every three years. Medical items (limited to approved types of supplies and equipment, suitable for use in the home). Benefit includes prosthetics and orthotics and respiratory equipment and supplies. Includes intermittent or part-time nursing services (R.N.or L.P.N.), personal care services by a home health aide, and medical items (limited to approved types of supplies and equipment, suitable for use in the home). All services and equipment must be ordered by a participating provider. Your PCP must notify Magellan Complete Care for services or equipment that requires home health care. Home health care does not include homemaker services, Meals on Wheels, companion, sitter or social services. 17

17 Service Home Health Care Services and Private Duty Nursing Care Hospital Ancillary Services Immunizations Independent Laboratory and Portable X-Ray Services Inpatient Hospital Services Description Magellan Complete Care covers home health services that are medically necessary. Home health services include home health visits (nurse and home health aide), private duty nursing and personal care services for children, therapy services medical supplies and durable medical equipment. Home healthcare does not include homemaker services, Meals on Wheels, companion, sitter or social services. Magellan Complete Care follows the state Medicaid Home Health Services Coverage and Limitations Handbook. When your provider authorizes these to be provided by the hospital: radiology, pathology, neurology, neonatology, and anesthesiology. According to childhood immunization schedule as approved by the appropriate Recommended Childhood Immunization Schedule for the United States. Includes laboratory and X-ray services when ordered by a participating provider. Includes all items and services needed to give appropriate care during a stay at a participating hospital, including room and board, nursing care, medical supplies, and all diagnostic and therapeutic services. Magellan Complete Care covers a maximum of 45 inpatient days for the period from July 1 through June 30 (includes only non-emergency care at hospitals where prior notification was obtained by your PCP from Magellan Complete Care). Magellan Complete Care will give up to three-hundred sixty-five (365) days of health-related inpatient care for all pregnant adults and child/ teenage enrollees under the age of twenty-one (21) years. Interpreter Services Maternity Services If you are in need of interpreter services or are vision and/or hearing impaired, please call the Customer Service phone number on the back of your ID card. These services are free of charge for all foreign languages as well as the visually and/or hearing impaired. Maternity services include the following: nursing assessment and counseling, Florida s Health Start Prenatal Risk Screening, nutrition assessment, delivery and follow-up care, Florida s Health Start Infant (Postnatal) Screening, and follow-up care. 18

18 Service Mental Health and Substance Abuse Services Nursing Facility Services Outpatient Services Physician Services Prescribed Drugs Therapy Services: Physical, Respiratory, Occupational and Speech therapies Description Mental Health counseling and referral services or substance abuse services; Please call our Customer Service Team or your assigned Health Guide so that we can provide further information about all of these benefits. You can contact us at Nursing facility services are provided to enrollees under the age of eighteen (18) years. Outpatient services provided in an outpatient hospital setting. Your PCP can obtain prior notification for health care services that may require notification. Includes all services and procedures rendered by a participating provider when needed for preventive, diagnostic, therapeutic, or to treat a particular injury, illness or disease. Excludes experimental procedures and cosmetic surgery. These physicians include: advanced registered nurse practitioner, physician assistant, podiatry, ambulatory surgical centers, community health departments, rural health clinic services, federally qualified health centers, birthing centers, certified nurse midwives, chiropractic, psychiatrist and nursing care. Includes prescribed drugs currently covered by the Medicaid Program, when ordered by a participating provider and supplied by a licensed participating pharmacy. Are covered for recipients under 21 years of age as medically necessary. 19

19 Service Transportation Description Magellan Complete Care offers transportation to and from your covered medical and dental appointments. Medicaid-eligible, nonemergency medical transportation services are offered by Veyo. To schedule a ride, please call at least 3 business days (72 hours) before you need to be picked up. If you need to cancel or reschedule your trip, or if your ride is late to pick you up, please call for help. Please Note: Call 911 if you have an emergency and need to be taken to the hospital. You can also call our customer service for assistance at Vision Services Vision services include eye exams and up to two pairs of standard eyeglasses per year. Contact lenses for cosmetic purposes are not covered. 20

20 Expanded Services Service Benefit OK from Doctor and Magellan Needed Dental expanded for adults Maximum $1500 benefit Preventive services one cleaning and oral exam every six months One x-ray per year One fluoride treatment per year Treatment for periodontal disease Yes for treatment of periodontal disease Home Health Visits enhanced for non- pregnant adults Can exceed three visits per day No limit when your doctor says it is needed Yes Intensive Outpatient Therapy for Substance Abuse No limits when medically necessary Yes Nutritional Counseling Up to 15 visits per year when your doctor says it is needed OB Visits visits for routine pregnancy care No limit for high risk pregnancy care One postpartum home visit Outpatient Hospital Services $500 per year plus the Medicaid benefits of $1500 based on medical necessity and in lieu of hospital admission Yes No Yes Over the Counter Medication/Supplies Certain over the counter medications and supplies See drug and supply list on web site No required prescription Post discharge meals Post discharge from inpatient admission; Up to 48 hours for member and up to three family members; requires 48 hours notice by member Yes 21

21 Service Primary Care Visits enhanced for non-pregnant adults Benefit One per day Not limited to two per month OK from Doctor and Magellan Needed No Vaccines adult Pneumonia and Shingles shots one per lifetime Flu shot one per year for members 19 and over Vision Services Routine eye exam and glasses once every 12 months Additional exams and glasses with OK from doctor For Specialty Fits (new wearers, historic, RGP, multi-focal, etc.), the enrollee must pay for any charges over $50, less a 20 percent discount No Yes for services beyond the annual benefit Co-pays Waived Yes Additional Notes for Covered Services Service Dental adult Diabetes Care Family Planning Services Benefit All dental treatment or surgery is considered necessary when the dental condition is likely to result in a medical condition if left untreated. We cover all needed equipment, supplies, and services to treat diabetes, including selfmanagement training and educational services if ordered by your doctor. May get services from any participating Medicaid provider OK from Doctor and Magellan Needed Yes No No 22

22 Service Inpatient Hospital Services Benefit Members over the age of 21 are limited to 45 days per Medicaid fiscal year There is no limit for members under the age of 21 or for emergency care and pregnant adults. OK from Doctor and Magellan Needed Yes Outpatient Services There is no limit for members under the age of 21. Yes Physician Services Therapeutic Group Care Women s Health May be given by individuals who are not licensed physicians, including nurse practitioners and physician assistants, when under the direction of your PCP Limited to one visit per day unless for an emergency, one new patient evaluation, one long term care facility visit per month Therapeutic group care services or specialized therapeutic group care are community-based, psychiatric residential treatment services designed for recipients under the age of 21 years with moderate to severe emotional disturbances. They are provided in a licensed residential group home setting serving no more than 12 recipients. Providers must comply with the regulations and requirements listed in the Specialized Therapeutic Services Coverage and Limitations Handbook. A copy of the authorization form for this service can be found in our website under the provider section: Authorizations. A female member, without an OK from her PCP, may visit a contracted obstetrician/gynecologist (OB/GYN) for one annual visit and for medically necessary follow up care as a result of that visit. No Yes No The benefit information provided is a brief summary, not a complete description of benefits; limitations and restrictions may apply and benefits may change. We provide coverage for all services identified by the State of Florida. No services are excluded due to religious or moral objections of Magellan Complete Care. 23

23 Fees for Members Living in Residential Facilities Per the Florida Department of Children and Families (DCF), Magellan Complete Care is in charge of making sure that members are charged and pay the amounts that they owe. Some members may not owe fees. This may happen because of their low income. It can also happen because of the way the amount owed is worked out. Magellan Complete Care can give the task of getting its members fees to the residential providers and pay the residential providers a net of the fee amount. If Magellan Complete Care lets the residential provider get the fees, the residential provider contract will give full details of both groups tasks on getting the members fees. Magellan Complete Care can either get the members fees from all of its providers or give the collection to all of its residential providers. Services Not Covered by Magellan Complete Care Routine, out of service area care is not covered by Magellan Complete Care. Only emergency (ER) services are covered. If you feel you need care while you are out of the service area call Magellan Complete Care at If you are hearing impaired, call our TTY number toll free at There are additional services that are covered directly through the Medicaid State Plan. Please call us at or our TTY only, for more information or contact the local Medicaid Office. Magellan Complete Care does not offer long-term care institutional services, institutional services for persons with developmental disabilities or state hospital services. Under this plan, routine services that are provided by providers that are not part of the Magellan Complete Care Network are not covered unless there are special situations. For more information, contact Magellan Complete Care at If you are hearing impaired, call our TTY number toll free at

24 How to Get Medications Magellan Complete Care covers prescription drugs and certain over-the-counter drugs. Please call us at or TTY only, for more information or visit the website for the Preferred Drug List. Go to a pharmacy that is signed up with Magellan Complete Care. See your Provider Directory or check the Provider Search online for a list of pharmacies near you. You can also call us at or TTY only, to help you find a pharmacy. At the pharmacy, show them your Magellan Complete Care ID card. Give them your prescription from your doctor. Some medications require an okay from us before the prescription can be filled. Your doctor will call us to get the okay. Informed Consent for Certain Drugs We require our doctors to get written permission informed consent from a parent or legal guardian before prescribing certain drugs to children under the age of 13. These drugs are psychotropic (psychotherapeutic) drugs and include antipsychotics, antidepressants, antianxiety medications, and mood stabilizers. Anticonvulsants and attention-deficit/ hyperactivity disorder (ADHD) medications (stimulants and non-stimulants) are not included at this time. Approval from us may also be required for prescriptions for these drugs. If you have questions, please call us at If you are hearing impaired, call our TTY number toll free at Specialty Medications Magellan Complete Care is working with Magellan Rx Specialty pharmacy to make it easy for you to quickly get your specialty medicine. These medicines often need special storage or handling. This specialty pharmacy will help you by providing written information about your condition and medicine. You get free delivery of your medicine to your home or another address. And nurses are there to answer your questions. You can call the specialty pharmacy at or their TTY/TDD number at If you do not want to use Magellan Rx Specialty pharmacy, you can call them and let them know. 25

2016 Medicaid Member Handbook and Welcome Kit

2016 Medicaid Member Handbook and Welcome Kit FLORIDA 2016 Medicaid Member Handbook and Welcome Kit MAGELLAN COMPLETE CARE 1-800-327-8613 www.mccoffl.com Table of Contents Introduction and First Steps................... 2 About Magellan Complete

More information

Florida Managed Medical Assistance Program:

Florida Managed Medical Assistance Program: Florida Managed Medical Assistance Program: Program Overview Agency for Health Care Administration Division of Medicaid Table of Contents Why Are Changes Being Made to Florida s Medicaid Program?... 3

More information

Member Handbook. SunshineHealth.Com

Member Handbook. SunshineHealth.Com Member Handbook SunshineHealth.Com Table of Contents Other Formats Available 6 Interpreter Services...6 Non-discrimination. 7 WELCOME & RESOURCES 8 Welcome to Sunshine Health. 8 Member Handbook..8 Provider

More information

Choosing a Managed Care Plan for Medicaid Long-Term Care

Choosing a Managed Care Plan for Medicaid Long-Term Care A Guide for Florida Advocates Choosing a Managed Care Plan for Medicaid Long-Term Care How Is Florida Medicaid Changing its Long-Term Care Services? From August 2013 through March 2014, the Florida Medicaid

More information

Benefits. Benefits Covered by UnitedHealthcare Community Plan

Benefits. Benefits Covered by UnitedHealthcare Community Plan Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current

More information

MMA Benefits at a Glance

MMA Benefits at a Glance MMA Benefits at a Glance You must get covered services by providers that are part of the Molina plan. You must also make sure that approval is obtained if needed. Ambulance Art Therapy Assistive Care Services

More information

An MMA Specialty Plan from Freedom Health. Medicaid. Member Handbook

An MMA Specialty Plan from Freedom Health. Medicaid. Member Handbook An MMA Specialty Plan from Freedom Health Medicaid Member Handbook Member Handbook An MMA Specialty Plan from Freedom Health Welcome to Freedom 1st! Thank you for choosing Freedom Health or Optimum HealthCare

More information

Out-of-Home Treatment Services for Children in Managed Care

Out-of-Home Treatment Services for Children in Managed Care Out-of-Home Treatment Services for Children in Managed Care Residential Mental Health Treatment in Florida (Ch. 39 & 394 F.S.) December 8, 2015 1 Presenters Heather Allman, LCSW Agency for Health Care

More information

Covered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice

Covered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice Covered Services Covered Services List and s and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice This chart tells you two things: 1. the covered services and benefits

More information

Member Handbook. Website: CMSPlan.floridahealth.gov

Member Handbook. Website: CMSPlan.floridahealth.gov Member Handbook This information is available for free in other languages. Please contact our customer service number at 1-866-376-2456 (TTY/TDD 1-800-955-8771) Monday to Friday from 8:00am to 5:00pm EST.

More information

community. Welcome to the Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC _001

community. Welcome to the Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook  CSPA15MC _001 Welcome to the community. Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC3673270_001 www.chipcoverspakids.com Telephone Numbers Member Services Monday Friday, 8:00 a.m.

More information

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Los Angeles County, CA H3237_2015_0291 CMS Accepted 09082014 Health Net Cal MediConnect Summary of Benefits! This is a

More information

Member Handbook. Website:

Member Handbook. Website: Member Handbook This information is available for free in other languages. Please contact our customer service number at 1-866-209-5022 (TTY/TDD 1-855-655-5303 Monday to Friday from 8:00am to 7:00pm. WELCOME

More information

Covered Services List

Covered Services List CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list

More information

Member Handbook. Real. Solutions. Amerigroup Florida, Inc. Florida Statewide Medicaid Managed Care Long-Term Care Program

Member Handbook. Real. Solutions. Amerigroup Florida, Inc. Florida Statewide Medicaid Managed Care Long-Term Care Program Real Solutions B-TXMHB-0004-11 05.11 FL-MHB-0023-13 10.13 Member Handbook Amerigroup Florida, Inc. Florida Statewide Medicaid Managed Care Long-Term Care Program 1-877-440-3738 n www.myamerigroup.com/fl

More information

Enrollment, Eligibility and Disenrollment

Enrollment, Eligibility and Disenrollment Section 2. Enrollment, Eligibility and Disenrollment Enrollment: Enrollment in Medicaid Programs: The State of Florida (State) has the sole authority for determining eligibility for Medicaid and whether

More information

RFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS

RFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,

More information

Member Handbook. Amerigroup Florida, Inc (TTY 711) Florida Statewide Medicaid Managed Care Long-Term Care Program

Member Handbook. Amerigroup Florida, Inc (TTY 711) Florida Statewide Medicaid Managed Care Long-Term Care Program Member Handbook Amerigroup Florida, Inc. Florida Statewide Medicaid Managed Care Long-Term Care Program 1-877-440-3738 (TTY 711) www.myamerigroup.com/fl Amerigroup Florida, Inc. Member Handbook Florida

More information

Certificate of Coverage

Certificate of Coverage Certificate of Coverage This Certificate of Coverage is issued by Molina Healthcare of Illinois, Inc., an Illinois corporation, operating as a health maintenance organization, hereinafter referred to as

More information

Medi-Cal. Member Handbook. A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form)

Medi-Cal. Member Handbook. A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form) Medi-Cal Member Handbook A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form) Benefit Year 2016 AS A HEALTH NET COMMUNITY SOLUTIONS MEMBER, YOU HAVE THE RIGHT TO Respectful

More information

Covered Benefits Rhody Health Partners

Covered Benefits Rhody Health Partners Covered s Rhody Health Partners s Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current

More information

COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE

COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE This is a list of all covered services and benefits for MassHealth Standard and CommonHealth members enrolled

More information

SMMC: LTC and MMA. Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC

SMMC: LTC and MMA. Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC SMMC: LTC and MMA Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC 727.443.7898 Why should you care about SMMC Florida has 7M+ people 50 y/o + 4M+ Social Security beneficiaries 3.5M+ Medicare

More information

Post Award Forum for Florida s 1115 Managed Medical Assistance Waiver. Presented at the September 2014 Medical Care Advisory Committee Meeting

Post Award Forum for Florida s 1115 Managed Medical Assistance Waiver. Presented at the September 2014 Medical Care Advisory Committee Meeting Post Award Forum for Florida s 1115 Managed Medical Assistance Waiver Presented at the September 2014 Medical Care Advisory Committee Meeting Statewide Medicaid Managed Care (SMMC) Program The SMMC program

More information

Summary Of Benefits. FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk

Summary Of Benefits. FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk Summary Of Benefits FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk 2018 Molina Medicare Options Plus (HMO SNP) (866) 553-9494, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local

More information

HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care

HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care Health care and insurance benefits can be difficult to understand. This guide introduces you to your basic Medi-Cal benefits, to the Health

More information

Florida s Medicaid 1115 Managed Medical Assistance Waiver Post Award Forum

Florida s Medicaid 1115 Managed Medical Assistance Waiver Post Award Forum Florida s Medicaid 1115 Managed Medical Assistance Waiver Post Award Forum Agency for Health Care Administration November 1, 2017 Public Meeting 1115 Research and Demonstration Waivers Section 1115 of

More information

PeachCare for Kids. Handbook

PeachCare for Kids. Handbook PeachCare for Kids Handbook Table of Contents What is PeachCare for Kids?...2 Who is eligible?...3 How do you apply for PeachCare for Kids?...3 Who will be your child s primary doctor?...4 Your child s

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California

More information

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service) Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2011 December 31, 2011 Los Angeles County This publication is a supplement to the 2011 Positive (HMO SNP) Evidence

More information

Title 21 Member Handbook

Title 21 Member Handbook Title 21 Member Handbook This information is available for free in other languages. Please contact our customer service number at 1-866-202-1132 (TTY/TDD 1-855-655-5303) Monday to Friday from 8:00am to

More information

Molina Healthcare of Florida Community Connector Program. Jeffrey T King, RN, MBA VP Healthcare Services

Molina Healthcare of Florida Community Connector Program. Jeffrey T King, RN, MBA VP Healthcare Services Molina Healthcare of Florida Community Connector Program Jeffrey T King, RN, MBA VP Healthcare Services Our Mission To provide quality health care to people receiving government assistance Escambia Santa

More information

Services Covered by Molina Healthcare

Services Covered by Molina Healthcare Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services

More information

Sunshine Health Managed Medical Assistance (MMA) Program

Sunshine Health Managed Medical Assistance (MMA) Program Sunshine Health Managed Medical Assistance (MMA) Program 1 Three Key Products Sunshine Health Managed Medical Assistance (MMA) Sunshine Health Child Welfare Sunshine Health Tango Plan Long-Term Care (LTC)

More information

COVERED SERVICES FOR NHP MASSHEALTH MEMBERS

COVERED SERVICES FOR NHP MASSHEALTH MEMBERS COVERED SERVICES FOR NHP MASSHEALTH MEMBERS Neighborhood Health Plan Covered Services for MassHealth Standard & CommonHealth, Family Assistance, and CarePlus Issued and effective October 1, 2015 nhp.org/member

More information

community. Welcome to the Tennessee TennCare 2017 United Healthcare Services, Inc. All rights reserved. CSTN17MC _000

community. Welcome to the Tennessee TennCare 2017 United Healthcare Services, Inc. All rights reserved. CSTN17MC _000 Welcome to the community. Tennessee TennCare 2017 United Healthcare Services, Inc. All rights reserved. Welcome to UnitedHealthcare Community Plan. We re happy to have you as a member. Your new health

More information

Community. Welcome to the. Hawai i. QUEST Integration Member Handbook Serving the islands of: Hawai i, Kauai, Lanai, Maui, Molokai and Oahu

Community. Welcome to the. Hawai i. QUEST Integration Member Handbook Serving the islands of: Hawai i, Kauai, Lanai, Maui, Molokai and Oahu Welcome to the Community Hawai i QUEST Integration Member Handbook Serving the islands of: Hawai i, Kauai, Lanai, Maui, Molokai and Oahu 2017 United Healthcare Services, Inc. All rights reserved. CSHI17MC4043565_000

More information

Covered Benefits Rhody Health Partners ACA Adult Expansion

Covered Benefits Rhody Health Partners ACA Adult Expansion Covered s Rhody Health Partners ACA Adult Expansion Abortion Services Adult Day Services AIDS Medical and Non-Medical Case Management Alcohol and Substance Abuse Treatment Cosmetic Surgery Dental Care

More information

Summary Of Benefits. WASHINGTON Pierce and Snohomish

Summary Of Benefits. WASHINGTON Pierce and Snohomish Summary Of Benefits WASHINGTON Pierce and Snohomish 2018 Molina Medicare Choice (HMO SNP) (800) 665-1029, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local time H5823_18_1099_0007_WAChoSB Accepted 9/26/2017

More information

IV. Benefits and Services

IV. Benefits and Services IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to

More information

Statewide Medicaid Managed Care Re-Procurement Update

Statewide Medicaid Managed Care Re-Procurement Update Statewide Medicaid Managed Care Re-Procurement Update Beth Kidder Deputy Secretary for Medicaid Presented to: House Health & Human Services Committee October 10, 2017 1 Statewide Medicaid Managed Care

More information

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)

Information for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service) Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2015 December 31, 2015 Los Angeles County This publication is a supplement to the 2015 Evidence of Coverage and

More information

HOW TO GET SPECIALTY CARE AND REFERRALS

HOW TO GET SPECIALTY CARE AND REFERRALS THE BELOW SECTIONS OF YOUR MEMBER HANDBOOK HAVE BEEN REVISED TO READ AS FOLLOWS HOW TO GET SPECIALTY CARE AND REFERRALS If you need care that your PCP cannot give, he or she will REFER you to a specialist

More information

BadgerCare Plus 2018 MEMBER HANDBOOK

BadgerCare Plus 2018 MEMBER HANDBOOK BadgerCare Plus 2018 MEMBER HANDBOOK 2 Important Quartz Phone Numbers 3 Welcome 3 Using Your ForwardHealth ID Card 3 Choosing A Primary Care Physician (PCP) 4 Emergency Care 4 Urgent Care 5 Care When You

More information

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION RFI /15 PROVISION OF NON-EMERGENCY TRANSPORTATION SERVICES

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION RFI /15 PROVISION OF NON-EMERGENCY TRANSPORTATION SERVICES STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION RFI 003-14/15 PROVISION OF NON-EMERGENCY TRANSPORTATION SERVICES A. BACKGROUND/PURPOSE 1. Background In accordance with section

More information

Services Covered by Molina Healthcare

Services Covered by Molina Healthcare Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered

More information

Provider Manual Section 7.0 Benefit Summary and

Provider Manual Section 7.0 Benefit Summary and Provider Manual Section 7.0 Benefit Summary and Exclusions Table of Contents 7.1 Benefit Summary 7.2 Services Covered Outside Passport Health Plan 7.3 Non-Covered Services Page 1 of 7 7.0 Benefit Summary

More information

We are ready to help! Call SuperiorHealthPlan.com

We are ready to help! Call SuperiorHealthPlan.com We are ready to help! Call 1-877-644-4494 SuperiorHealthPlan.com SHP_2013390 12_2013 Numbers to Remember If you have any questions, call us at 1-877-644-4494. Superior s Member Services staff will help

More information

Statewide Medicaid Managed Care Long-term Care Program

Statewide Medicaid Managed Care Long-term Care Program Statewide Medicaid Managed Care Long-term Care Program Questions and Answer Session for Aging Network Providers July 1, 2013 9:00-10:00 a.m. 1 Welcome to the Question and Answer Webinar Meeting for Aging

More information

Member Handbook. Effective Date: January 1, Revised October 30, 2017

Member Handbook. Effective Date: January 1, Revised October 30, 2017 Member Handbook Effective Date: January 1, 2018 Revised October 30, 2017 2017 NH Healthy Families. All rights reserved. NH Healthy Families is underwritten by Granite State Health Plan, Inc. MED-NH-17-004

More information

Our service area includes these counties in: Florida: Broward, Miami-Dade.

Our service area includes these counties in: Florida: Broward, Miami-Dade. 2018 SUMMARY OF BENEFITS Overview of your plan Preferred Medicare Assist (HMO SNP) H1045-012 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer Service

More information

Enhanced Utilization Management Model

Enhanced Utilization Management Model PROVIDER PRESENTATION UPDATE Enhanced Utilization Management Model Physical Therapy, Speech Therapy and Occupational Therapy 12/18/17 Provider Training Tool Publication Enhanced Utilization Management

More information

Better Quality Is Our Goal

Better Quality Is Our Goal FLORIDA 2016 ISSUE II Better Quality Is Our Goal We at Staywell want to deliver great care and service to our members. That s why we created our Quality Improvement (QI) Program. The program s goal is

More information

Title 21 Member Handbook

Title 21 Member Handbook Title 21 Member Handbook This information is available for free in other languages. Please contact our customer service number at 1-866-376-2456 (TTY/TDD 1-800-955-8771) Monday to Friday from 8:00am to

More information

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans The presentation will begin momentarily. Please dial in to hear audio: 1-888-670-3525

More information

NY EPO OA 1-09 v Page 1

NY EPO OA 1-09 v Page 1 PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)

More information

PARTICIPANT HANDBOOK. City and County of San Francisco Department of Public Health Updated February 2017

PARTICIPANT HANDBOOK. City and County of San Francisco Department of Public Health Updated February 2017 PARTICIPANT HANDBOOK City and County of San Francisco Department of Public Health Updated February 2017 www.healthysanfrancisco.org Contents About this Handbook...1 What is Healthy San Francisco?...1 Your

More information

MEMBER HANDBOOK. Health Net HMO for Raytheon members

MEMBER HANDBOOK. Health Net HMO for Raytheon members MEMBER HANDBOOK Health Net HMO for Raytheon members A practical guide to your plan This member handbook contains the key benefit information for Raytheon employees. Refer to your Evidence of Coverage booklet

More information

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin

HealthPartners Freedom Plan (Cost) 2011 Medical Summary of Benefits Wisconsin HealthPartners Freedom Plan 2011 Medical Summary of Benefits Wisconsin HealthPartners Wisconsin Freedom Plan I HealthPartners Wisconsin Freedom Plan II 420421 (10/10) H2462_SB WI_151 CMS Approved 10/5/10

More information

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus

More information

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult

More information

Other languages and formats

Other languages and formats Dear member, We re glad you re part of our health plan! It s important to us that you have the most up-to-date information about your benefits. We re sending you the following notices with this letter:

More information

Statewide Medicaid Managed Care Long-term Care Program. Judy Jacobs Agency for Health Care Administration Area 7 Field Office Manager April 9, 2013

Statewide Medicaid Managed Care Long-term Care Program. Judy Jacobs Agency for Health Care Administration Area 7 Field Office Manager April 9, 2013 Statewide Medicaid Managed Care Long-term Care Program Judy Jacobs Agency for Health Care Administration Area 7 Field Office Manager April 9, 2013 Overview Part 1: What is Managed Care? Part 2: Legislation

More information

HOW TO GET SPECIALTY CARE AND REFERRALS

HOW TO GET SPECIALTY CARE AND REFERRALS THE BELOW SECTIONS OF YOUR MEMBER HANDBOOK HAVE BEEN REVISED TO READ AS FOLLOWS HOW TO GET SPECIALTY CARE AND REFERRALS If you need care that your PCP cannot give, he or she will refer you to a specialist

More information

Mapped Facts and Figures Florida s Ocean and Coastal Economies

Mapped Facts and Figures Florida s Ocean and Coastal Economies Mapped Facts and Figures Florida s Ocean and Coastal Economies Professor Judith Kildow, Principal Investigator California State University Monterey Bay September 2006 INFORMATION INCLUDED Florida and Regions

More information

For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com or call us for more information.

For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com or call us for more information. This Summary of Benefits contains 2018 plan information for: Geisinger Gold Secure Rx (HMO SNP) For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com

More information

Guide to Accessing Quality Health Care Spring 2017

Guide to Accessing Quality Health Care Spring 2017 Guide to Accessing Quality Health Care Spring 2017 MolinaHealthcare.com 5771749DM0217 MyMolina MyMolina is a secure web portal that lets you manage your own health from your computer. MyMolina.com is easy

More information

BlueCare SM. Member Handbook. A Guide to Your Health Plan

BlueCare SM. Member Handbook. A Guide to Your Health Plan BlueCare SM 2014 Member Handbook A Guide to Your Health Plan (inside front cover) FREE Phone Numbers to call for help BlueCare call about your health care 1-800-468-9698 BlueCare CHOICES in Long-Term Services

More information

INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS

INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS INTRODUCTION TO SUMMARY OF BENEFITS SECTION 1 SUMMARY OF BENEFITS January 1, 2015 - December 31, 2015 CARE1ST HEALTH PLAN California: Fresno, Merced, Stanislaus and San Joaquin Counties H5928_15_029_SB_CTCA_2

More information

Medi-Cal Program. Benefit. Benefits Chart

Medi-Cal Program. Benefit. Benefits Chart Chart Please note that the table below is only a summary. More details about benefits can be found in the section of the Medi-Cal Evidence of Coverage booklet. All health care is arranged through your

More information

UnitedHealthcare Community Plan Alliance Member Handbook

UnitedHealthcare Community Plan Alliance Member Handbook CAPITAL AREA UnitedHealthcare Community Plan Alliance Member Handbook 941-1057 8/11 Important Phone Numbers Member Services.... 1-800-701-7192 (8 a.m. 5:30 p.m., Monday Friday).... TTY: 711 NurseLine Services

More information

Freedom Blue PPO SM Summary of Benefits

Freedom Blue PPO SM Summary of Benefits Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR

More information

Tufts Health Unify Member Handbook

Tufts Health Unify Member Handbook 2016 Tufts Health Unify Member Handbook H7419_5364 CMS Accepted Tufts Health Unify Member Handbook January 1, 2016 December 31, 2016 Your Health and Drug Coverage under the Tufts Health Unify Medicare-Medicaid

More information

Quick Reference Card

Quick Reference Card Amerigroup District of Columbia, Inc. Quick Reference Card Precertification/notification requirements Important contact numbers n Revenue codes https://providers.amerigroup.com/dc DCPEC-0176-17 Important

More information

OVERVIEW OF YOUR BENEFITS

OVERVIEW OF YOUR BENEFITS OVERVIEW OF YOUR BENEFITS IMPORTANT PHONE NUMBERS Member Services Department (646) 473-9200 For answers to questions about your benefits or to be referred to another Benefit Fund department. Program for

More information

Summary Of Benefits. Molina Medicare Options Plus (HMO SNP) (866) , TTY/TDD days a week, 8 a.m. 8 p.m. local time

Summary Of Benefits. Molina Medicare Options Plus (HMO SNP) (866) , TTY/TDD days a week, 8 a.m. 8 p.m. local time Summary Of Benefits OHIO Brown, Butler, Clark, Clermont, Clinton, Columbiana, Delaware, Fairfield, Fayette, Franklin, Greene, Hamilton, Highland, Hocking, Lake, Madison, Miami, Montgomery, Morrow, Perry,

More information

Welcome to the Molina family.

Welcome to the Molina family. Welcome to the Molina family. Ohio Member Handbook Date of Issuance, July 2013 Table of Contents Member Handbook Welcome...3 Member Services...4 24-Hour Nurse Advice Line...5 Identification (ID) Cards...5

More information

WHAT DOES MEDICALLY NECESSARY MEAN?

WHAT DOES MEDICALLY NECESSARY MEAN? WHAT DOES MEDICALLY NECESSARY MEAN? Your Primary Care Provider (PCP) will help you get the services you need that are medically necessary as defined below. Medically Necessary means appropriate and necessary

More information

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned

More information

MEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.

MEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS. ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction

More information

Guide to Accessing Quality Health Care Spring 2017

Guide to Accessing Quality Health Care Spring 2017 Guide to Accessing Quality Health Care Spring 2017 MolinaHealthcare.com 5771753DM0217 MyMolina MyMolina is a secure web portal that lets you manage your own health from your computer. MyMolina.com is easy

More information

Avmed medicare. Keeping You Informed

Avmed medicare. Keeping You Informed Avmed medicare Keeping You Informed Summer/July 2016 inside Your Primary Care Physician... 2 Preventive Healthcare... 2 Transferring Your Medical Records... 3 Mental Health Benefits... 3 Medical Technology...

More information

Summary of Benefits. Allwell Dual Medicare (HMO SNP) Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk and Volusia counties, Florida

Summary of Benefits. Allwell Dual Medicare (HMO SNP) Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk and Volusia counties, Florida 2018 Summary of Benefits Allwell Dual Medicare (HMO SNP) Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk and Volusia counties, Florida H5190-001 Benefits effective January 1, 2018 H5190_18_2801SB_A_Accepted

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Jade (HMO SNP) Kern, Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0175 CMS Accepted 09082015

More information

WELCOME to Kaiser Permanente

WELCOME to Kaiser Permanente WELCOME to Kaiser Permanente PPO PLAN RESOURCE GUIDE Colorado kp.org/kpic-colorado Greetings Subscriber name, we re glad to be your partner on this journey, and we look forward to a long and healthy relationship

More information

Blue Shield Gold 80 HMO 0/30 + Child Dental INF

Blue Shield Gold 80 HMO 0/30 + Child Dental INF Blue Shield Gold 80 HMO 0/30 + Child Dental INF Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX

More information

Complete Senior Care Enrollment Agreement

Complete Senior Care Enrollment Agreement Complete Senior Care Enrollment Agreement I have received the Enrollment Handbook and a copy of the Provider Network and have had the opportunity to ask questions. Name: Address: (First) (Middle) (Last)

More information

Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties

Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties Summary of Benefits New York: Bronx, Kings, New York, Queens and Richmond Counties January 1, 2006 - December 31, 2006 You ve earned the right to live life on your own terms. And that includes the right

More information

Early and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training

Early and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training Early and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training EPSDT Overview EPSDT purpose and requirements mandated by the Agency for Health Care Administration

More information

Welcome to Regence! Meet your employer health plan

Welcome to Regence! Meet your employer health plan is an Independent Licensee of the Blue Cross and Blue Shield Association Regence BlueCross BlueShield of Utah Welcome to Regence! Meet your employer health plan 1 Health insurance is a big, wonderful benefit.

More information

Gold Access+ HMO 500/35 OffEx

Gold Access+ HMO 500/35 OffEx An Independent Member of the Blue Shield Association Gold Access+ HMO 500/35 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective

More information

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims. HOPE COLLEGE - HOURLY ORANGE 007013084/0011/0012/0013/0014/0015/0016/0017 Simply Blue PPO HSA ASC Effective Date: On or after July 2018 Benefits-at-a-glance This is intended as an easy-to-read summary

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services

More information

MyHPN Solutions HMO Gold 7

MyHPN Solutions HMO Gold 7 MyHPN Solutions HMO Gold 7 HIOS ID: 95865NV0030074 Attachment A Benefit Schedule Calendar Year Deductible (CYD): $3,000 of EME per Member and $6,000 of EME per family. The Calendar Year Out of Pocket Maximum

More information

Welcome to the Molina family.

Welcome to the Molina family. Welcome to the Molina family. Member Handbook Molina Healthcare of Illinois Integrated Care Program Issued October 2013 Important Molina Healthcare Phone Numbers Member Services (855) 766-5462 TTY/Illinois

More information

CUSTOMER SERVICE MEMBER FOCUS A NEW WAY TO REACH. Hawai i 2017 Issue I NUMBERS TO KNOW

CUSTOMER SERVICE MEMBER FOCUS A NEW WAY TO REACH. Hawai i 2017 Issue I NUMBERS TO KNOW Hawai i 2017 Issue I MEMBER FOCUS A NEW WAY TO REACH CUSTOMER SERVICE At Ohana, we strive to provide the best member experience possible for you each and every day. We know navigating health care is challenging,

More information

member news In this issue: FirstCare STAR & CHIP November 2016 FirstCare Extra Benefits pg 4 Getting Answers to Your Questions pg 6

member news In this issue: FirstCare STAR & CHIP November 2016 FirstCare Extra Benefits pg 4 Getting Answers to Your Questions pg 6 member news November 2016 FirstCare STAR & CHIP In this issue: Quality Improvement (QI) Program pg 2 Services Needing Approval pg 3 Case Management Services pg 3 Interpretation Services pg 3 FirstCare

More information