<Date> <Member # > <RxID> <Name> <RxGroup> <Address> <RxBin> <City>, <State> <ZIP> Welcome to Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)!
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- Abner Rogers
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1 <Date> <Member # > <RxID> <Name> <RxGroup> <Address> <RxBin> <City>, <State> <ZIP> <RxPCN> IMPORTANT: YOU HAVE ENROLLED IN A NEW PLAN FOR YOUR MEDICARE AND MEDI-CAL SERVICES. <Name>: Welcome to Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)! Starting <effective date>, you will have a Cal MediConnect health plan designed to give you seamless, high quality care at no extra cost to you. Care1st Cal MediConnect Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Your new coverage includes: Your Medicare benefits, including prescription drugs. Your Medi-Cal benefits, including long-term services and supports (LTSS) that help you with on-going personal care needs. LTSS includes In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), and Community-Based Adult Services (CBAS), which are services that can help you stay in your home as long as possible. It also includes nursing home care if you need it. Your choice of doctors and other providers within our network who work together to give you the care you need. Extra benefits and services such as vision care, transportation services, a Care Navigator, and supplemental dental benefits. You may begin using Care1st Cal MediConnect Plan network primary care providers and pharmacies for all of your health care services and prescription drugs as of <effective date>. If you need emergency or urgently needed care, or out-of-area dialysis services, you can use providers outside of Care1st Cal MediConnect Plan s network. To help with the transition to Care1st Cal MediConnect Plan, you may be able to continue seeing the doctors you go to now for a period of up to six (6) months for Medicare services and a period of up to twelve (12) months for Medi-Cal services from the effective date of your enrollment in Care1st Cal MediConnect Plan. Contact Care1st Cal MediConnect Plan Member Services at (TTY: 711) for information on how to do this. You will also have access to at least one 30-day supply of the Part D drugs you currently take during your first 90 days in the plan if you are taking a drug that is not our List of Covered Drugs, if health plan rules do not let you get the amount ordered by your doctor, or if the drug requires prior approval by Care1st Cal MediConnect Plan. H0148_15_007_MS_VoluntLA Approved
2 This letter is proof of your new coverage. [Insert the following if the welcome mailing is separate from the ID Card mailing: <Please bring this letter with you to the pharmacy or office visit until you receive your Member ID Card from us.>] The new member kit includes: List of Covered Drugs (Formulary) Instructions for getting more information about the providers and pharmacies in our network [Insert the following if ID Card is included with the welcome mailing:<member ID Card>] [Insert the following if the EOC is included with the welcome mailing:<member Handbook (Evidence of Coverage)>] [Insert the following if the welcome mailing is separate from the ID Card and/or EOC mailing: Before your enrollment date, we will send you [<a Member ID card>] [and] [<a Member Handbook (Evidence of Coverage)>].] How much will I have to pay for Care1st Cal MediConnect Plan? You will not have to pay a plan premium, deductible, or copayments when receiving health services through a Care1st Cal MediConnect Plan provider. How much will I have to pay for prescription drugs? When you pick up your prescription drugs at our network pharmacy, you ll pay a reduced copayment or $0 copayment at the pharmacy. You ll pay no more than $2.65 each time you receive a generic drug that s covered by Care1st Cal MediConnect Plan, and no more than $6.60 each time you receive a brand name drug that is covered by Care1st Cal MediConnect Plan. Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact Care1st Cal MediConnect Plan for more details. How can I choose a primary care provider? To choose your Primary Care Provider (PCP), you can view the Care1st Cal MediConnect Plan Provider and Pharmacy Directory on our website at or call Member Services for help. You will get your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you need. Our plan s PCPs are affiliated with particular medical groups. When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are also affiliated with his or her medical group. So, if there is a particular Care1st Cal MediConnect Plan specialist or hospital that you want to use, it is important to see whether they are affiliated with your PCP s medical group. When you need specialty care or additional services your PCP cannot provide, he or she will give you a referral. In most cases, you must see your PCP to get a referral before you see any other health care providers or visit a specialist. Once this referral is approved by your PCP s
3 medical group, you can make an appointment with the specialist or other provider to receive the treatment you need. The specialist will let your PCP know when you have completed your treatment or service so your PCP can continue to manage your care. Also, your PCP will need to get approval in advance from the Plan for you to receive certain services. This approval in advance is called prior authorization. For example, prior authorization is required for all non-emergency inpatient hospital stays. In some cases, your PCP s affiliated medical group, instead of our plan, may be able to authorize your service. You can get certain services without first getting approval from your PCP, such as: emergency services, urgently needed care, kidney dialysis services, vaccinations, routine women s health care and family planning services, etc. What if I have other health or prescription drug coverage? If you have other health or drug coverage, such as from an employer or union, you or your dependents could lose your other health or drug coverage completely and not get it back if you join Care1st Cal MediConnect Plan. Other types of health and drug coverage include TRICARE, the Department of Veterans Affairs, or a Medigap (Medicare Supplement Insurance) policy. Contact your benefits administrator if you have questions about your coverage. If you want to cancel your enrollment, you may call Health Care Options at , Monday through Friday from 8:00 am to5:00 pm. TTY users should call Can I leave Care1st Cal MediConnect Plan after <effective date>? Yes. You may leave Care1st Cal MediConnect Plan at any time by calling Health Care Options at , Monday through Friday from 8:00 am to5:00 pm. TTY users should call You can also call MEDICARE ( ), 24 hours a day, 7 days a week (TTY users should call ). If you choose to leave Care1st Cal MediConnect Plan, your coverage will end the last day of the month after you tell us you want to leave. What if I want to join a different Cal MediConnect plan? If you want to keep getting your Medicare and Medi-Cal benefits together from a single plan, you can join a different Cal MediConnect plan. To enroll in a different Cal MediConnect plan, call Heath Care Options at , Monday through Friday from 8:00 am to 5:00 pm. TTY users should call Tell them you want to leave your current Cal MediConnect plan and join a different Cal MediConnect plan. If you are not sure what plan you want to join, they can tell you about other plans in your area. What happens to my Medicare if I leave Care1st Cal MediConnect Plan? If you leave Care1st Cal MediConnect Plan and don t join a Medicare health or prescription drug plan, you ll be covered under Original Medicare and Medicare will enroll you in a Medicare prescription drug plan. To join a Medicare plan, call MEDICARE ( ), 24 hours a day, 7 days a week (TTY users should call ). What happens to my Medi-Cal if I leave Care1st Cal MediConnect Plan? You must have a Medi-Cal health plan in order to continue to receive your Medi-Cal services, including long-term services and supports (LTSS) that help you with on-going personal care needs. If you leave your Cal Mediconnect plan, you will need to let Health Care Options know which Medi-Cal managed care plan you want to join. Call Health Care Options at , Monday through Friday from 8:00 am to 5:00 pm. TTY users should call
4 7077. Tell them you do not want to be enrolled in Care1st Cal MediConnect Plan and you want to join a Medi-Cal managed care plan. If you are not sure about which plan you want to join, they can tell you about other plans in your area. Who should I call if I have questions about Care1st Cal MediConnect Plan s coverage or providers? If you have questions, call Care1st Cal MediConnect Plan Member Services at , 8:00 a.m. 8:00 p.m., seven days a week. TTY users should call 711. You can also visit For help or more information If you want to talk to a health insurance counselor about these changes and your choices, call the California Health Insurance Counseling & Advocacy Program (HICAP) at If you have questions about Medicare, call MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call You can also visit If you need help enrolling in a Cal MediConnect or Medi-Cal plan, please call Health Care Options at , Monday through Friday from 8:00 am to 5:00 pm. TTY users should call If you are in a Cal MediConnect plan and need further help, call the Cal MediConnect Ombudsman at You can get this information for free in other languages. Call (TTY users should call 711). The call is free. Puede recibir esta información sin cargo en otros idiomas. Llame al Los usuarios de TTY deben llamar al 711. La llamada es gratuita. 您可免费获得本资讯的其他语言版本 请致电免费电话 , 听障及语障人士请致电 711 您可免費獲得本資訊的其他語言版本 請致電免費電話 聽障及語障人士請致電 711 Դուք կարող եք անվճար ստանալ այս տեղեկությունն այլ լեզուներով: Զանգահարեք հեռախոսահամարներով: TTY օգտվողները պետք է զանգահարել 711: Զանգն անվճար է: អ នកអ ចយកព ត ម ននន ន យឥតគ តថ ល ន កន ងភ ស នស ងន ត ន ន កអ នកដ លន ល TTY នលត ត រស ពទន លលខ 711 ក រន នន គ ឥតគ តថ ល 본정보를무료로다른언어로받아보실수있습니다 번으로전화해주십시오. TTY 사용자는 711 번으로전화해주십시오. 통화는무료입니다.
5 Эту информацию вы можете получить бесплатно в переводе на другие языки. Позвоните по телефону Пользователи TTY должны позвонить 711. Звонки по этому телефону бесплатные. Maaari ninyong makuha nang libre ang impormasyon na ito sa ibang mga wika. Tawagan ang Ang gumagamit ng TTY ay dapat tumawag sa 711. Libre ang tawag. u v c th nh n th ng tin n y mi n ph bằng c c ng n ng kh c. y g i Người sử dụng TTY nên g i 711. Cu c g i n y ư c mi n ph. ک ن ید دری اف ت دی گر های زب ان در رای گان صورت ب ه را اط العات ای ن ت وان ید می شما. رایگان است. ( ) تلفن خدمات ب رای (TTY) ب گ یری د ت ماس. 711 ت ل فن شماره ب ا يمكنك الحصول على هذه المعلومات مجانا في لغات أخرى. اتصل وال نطق ال سمع ض عاف (TTY) يجب على المستخدمين االتصال ب. 111 المكالمة مجانية. If you need this letter in another language or alternate format, like large print, audio, or Braille, or if you need help understanding this letter, please call Health Care Options at , Monday through Friday from 8:00 am to 5:00 pm. TTY users should call
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