A University of Hawai'i Cooperative Extension Service Project.
|
|
|
- Lynn Stewart
- 5 years ago
- Views:
Transcription
1 A University of Hawai'i Cooperative Extension Service Project
2 Increase your knowledge about Course Objectives financial planning Improve your ability to make informed decisions
3 Help for Caregivers on Medicare
4 Presenter State of Hawai i Executive Office on Aging Pamela Cunningham State Health Insurance Program Coordinator
5 Learn what caregivers need to Lesson Objectives know about Medicare Learn how to advocate on your recipient s behalf Learn how to protect personal identities of my recipient and myself
6 Medicare Card
7 Their Social Security number Medicare ID Number Social Security number of person qualified from (spouse, ex-spouse; parent s if young and disabled)
8 Medicare New Card Request Social Security
9 You can call Social Security or Caregiver Request Option 1 Medicare and have your care recipient give verbal permission for them to speak to you Care recipients will need to provide identifying information: Name, address, date of birth, social security number
10 Medicare Caregiver Request Option 2 Your care recipient can complete a form called Appointment of Representative and send it in Call (Medicare)
11 Social Security Caregiver Request Option 3 Your care recipient can complete a similar form Call (Social Security)
12 Medicare Health or Drug Plan Caregiver Request Option 4 Call the company directly for similar forms
13 Note: Caregiver Request Warning Medicare, Social Security and Medicare Health and Drug plans will NOT accept a Power of Attorney
14 Contact the health plan or plan Other Health Plan administrator for forms and what documents they will accept Call the Veterans Affairs (VA) for VA guidelines Retirement health plans -- call the health plan
15 Each Plan has own forms Other Insurance Call Medicare if unknown Go on-line to Sign Up/Change Plans on the banner and choose Check your enrollment
16 Toll-free number is available Medicare Contact Information 24/7 except for some holidays Medicare Health and Drug plans also have toll-free TTY numbers for the hearing impaired
17 Social Security Contact Information Social Security hotline is available from 7 a.m. 7 p.m. Monday through Friday except for some holidays Toll-free TTY numbers for the hearing impaired
18 Hawai'i State Health Insurance Assistance Program Hawai'i s State Health Insurance Assistance Program (SHIP) Call the Hawai'i SHIP Program
19 One-to-one counseling and Hawaii SHIP assistance to people with Medicare and their families Free counseling and assistance via telephone calls, face to face meetings and public education presentations/programs
20 Get information about: Key to Helping What coverage they have? How much they should be paying? What services are covered? Who are the providers?
21 Medicare Homework for the Caregiver Health Plan Who Do I Call?
22 Original Medicare? Identify Healthcare Plan Medicare Advantage Plan? Retirement option? Write down the contact numbers and hours of service and their website
23 Health Maintenance Organization Type of Plan: HMO (HMO) where they have to stay within a closed network to receive services Plan may not pay for services outside their network -- always check first
24 Preferred Provider Organization Type of Plan: PPO (PPO) where they pay less by using the plan s preferred network, but can still go outside the network and pay a little more These plans are easier to use out of your home state
25 Do they have a Medigap policy Type of Plan: Medigap (secondary payer to Medicare)? Medigap plans (Medicare Supplement) is sold by private insurance companies Plans differ by premiums and customer service, not benefits
26 Medicare and Social Security will Protect Your Identity NEVER call you asking you for your identification numbers Other identifying information is asked to verify speaking with you No printout from Social Security with your number on it
27 Keep your Medicare and Social Safety Precautions Security number in a safe place Don t carry it in your wallet except when needed (going to the doctor or applying for a new job)
28 If you do feel that your identity Alert has been compromised then please contact Medicare, Social Security and your financial institutions right away
29 Toll-free: Medicare Information TTY: Website: Mailing address: Centers for Medicare & Medicaid Services 7500 Security Blvd Baltimore, MD
30 Hawai'i s State Health Insurance Contact for More Information Assistance Program (SHIP) Hawai'i SHIP Program at: or
31 Take Charge of Your Money4 Website & TV Channels Visit Us TV channels
32 We would like to thank the following groups for their support: Credits University of Hawai'i at Mānoa College of Tropical Agriculture & Human Resources, Cooperative Extension Service, Department of Family & Consumer Sciences Information Technology Services-Academic Technologies State of Hawai'i Executive Office of Aging Hawai'i Social Security Administration
Evidence of Coverage
January 1 December 31, 2017 Evidence of Coverage Your Medicare Health Benefits and Services as a Member of Kaiser Permanente Medicare Plus (Cost) This booklet gives you the details about your Medicare
Get Your Medicare Questions Answered
Get Your Medicare Questions Answered Do you have questions about your Medicare coverage? 1-800-MEDICARE (1-800-633-4227) can help! TTY users should call 1-877-486-2048. What Should I Have Ready When I
Medicare Hospice Benefits
CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who s eligible for hospice care What services are
Health in Handbook. a guide to Medicare rights & health in Pennsylvania #6009-8/07
Health in Handbook a guide to Medicare rights & health in Pennsylvania #6009-8/07 Tips for Staying Healthy works hard to make sure that the health care you receive is the best care possible. There are
Evidence of Coverage:
January 1 December 31, 2013 Evidence of Coverage: Your Medicare Health Benefits and Services as a Member of Health Net Aqua (PPO) This booklet gives you the details about your Medicare health care coverage
Please carefully read and complete the following information before signing and dating this disenrollment form:
Health Net Medicare Advantage Plans Disenrollment Form If you request disenrollment, you must continue to get all medical care from Health Net until the effective date of disenrollment. Contact us to verify
Medicare Plus Blue SM Group PPO
2018 Medicare Plus Blue SM Group PPO Evidence of Coverage Your Medicare Health Benefits and Services as a Member of Medicare Plus Blue SM Group PPO This booklet gives you the details about your Medicare
Medicare Rights & Protections
CENTERS for MEDICARE & MEDICAID SERVICES Medicare Rights & Protections This official government booklet has important information about: Your rights & protections in: Original Medicare Medicare Advantage
EVIDENCE OF COVERAGE. January 1 December 31, Your Medicare Health Benefits and Services as a Member of Cigna HealthSpring Advantage (PPO)
January 1 December 31, 2018 EVIDENCE OF COVERAGE Your Medicare Health Benefits and Services as a Member of Cigna HealthSpring Advantage (PPO) This booklet gives you the details about your Medicare health
Medicare Hospice Benefits
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who is eligible for hospice care What services
For the Lifespan: The Caregiver Guide Module 12 Legal and Financial Matters: What You Need to Know
For the Lifespan: The Caregiver Guide Module 12 Legal and Financial Matters: What You Need to Know Objectives After completing this module, participants will be able to: Understand more about estate planning.
Evidence of Coverage. Elderplan Advantage for Nursing Home Residents (HMO SNP) H3347_EP16115_SALIS_
2018 Evidence of Coverage January 1, 2018 to December 31, 2018 H3347_EP16115_SALIS_01.25.2018 January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription
Dual Eligible Special Needs Plans For 2015
Dual Eligible Special Needs Plans For 2015 Introduction: Amerigroup Community Care is offering Dual Eligible Special Needs Plans (D-SNPs) to people who are eligible for both Medicare and Medicaid benefits
Mercy Care Advantage (HMO SNP) 2018 Evidence of Coverage Evidencia de Cobertura Visit/Viste
Mercy Care Advantage (HMO SNP) 2018 Evidence of Coverage Evidencia de Cobertura 2018 Visit/Viste www.mercycareadvantage.com AZ-17-07-02 January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health
2. Applications Submitted By Use Of inroads
the available Programs, wants to apply for SNAP benefits, the contact county screens for Expedited Service eligibility, explains this to the client and notifies the correct county office that this was
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is one of 12 states that has signed a Memorandum of Understanding
Annual Notice of Coverage
CHRISTUS Health Plan Generations (HMO) Annual Notice of Coverage Finally, access to the doctor and hospital you know and trust. christushealthplan.org CHRISTUS Health Plan Generations (HMO) offered by
Home Care for Cancer Patients. Key Points. Cancer patients often feel more comfortable and secure being cared for at home. Many
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Home Care for Cancer Patients
Voluntary Alignment Frequently Asked Questions
Voluntary Alignment Frequently Asked Questions Some Medicare beneficiaries may have recently received a letter and form in the mail asking them to confirm their main doctor or group practice. These letters
EVIDENCE OF COVERAGE Molina Medicare Options Plus HMO SNP
Molina Medicare Options Plus HMO SNP Member Services CALL (800) 665-0898 Calls to this number are free. 7 days a week, 8 a.m. to 8 p.m., local time. Member Services also has free language interpreter services
HealthPartners MSHO (HMO SNP) Enrollment Form
HealthPartners MSHO (HMO SNP) Enrollment Form HealthPartners Enrollment Telephone Numbers 952-883-5050 or 877-713-8215. TTY for the hearing impaired at 952-883-6060 or 800-443-0156. The call is free. HealthPartners
No other type of Medicare plan offers these services.
No other type of Medicare plan offers these services. A personal touch With UPMC for Life Options, you get all the benefits of Original Medicare (Parts A and B), plus prescription drug coverage, extra
Providers who see Empire Medicare Advantage HMO members also are considered contractually eligible to see Empire D-SNP members.
Empire BlueCross BlueShield FAQs for 2017 D-SNP Plans Introduction: Empire BlueCross BlueShield is offering Special Needs Plans (SNPs) to people who are eligible for both Medicare and Medicaid benefits
Welcome to Health Net
Welcome to Health Net When it comes to Medicare coverage, the right choice depends on your health, your budget and your lifestyle. Health Net makes choosing quality, cost-effective health care coverage
Your Medicare Health Benefits and Services as a Member of Cigna HealthSpring Advantage (HMO)
January 1 December 31, 2018 EVIDENCE OF COVERAGE Your Medicare Health Benefits and Services as a Member of Cigna HealthSpring Advantage (HMO) This booklet gives you the details about your Medicare health
Evidence of Coverage January 1 December 31, 2014
L.A. Care Health Plan Medicare Advantage (HMO SNP) Evidence of Coverage January 1 December 31, 2014 Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of L.A. Care Health
Medicare Hospice Benefits
CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who s eligible for hospice care What services are
Medicare & Your Mental Health Benefits
CENTERS for MEDICARE & MEDICAID SERVICES Medicare & Your Mental Health Benefits This official government booklet has information about mental health benefits for people with Original Medicare, including:
NeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
2018 Evidence of Coverage
Los Angeles, Riverside and San Bernardino Counties 2018 Evidence of Coverage SCAN Connections (HMO SNP) Y0057_SCAN_10165_2017F File & Use Accepted DHCS Approved 08232017 08/17 18C-EOC006 January 1 December
Medicare Plus Blue Group PPO. We have the solution.
Medicare Plus Blue Group PPO We have the solution. 1 What is Medicare Advantage? Plans offered by private insurance companies that contract with The Centers for Medicare and Medicaid Services (CMS). The
MEDIMASTER GUIDE. MediMaster Guide. Positively Aging /M.O.R.E The University of Texas Health Science Center at San Antonio
MEDIMASTER GUIDE MediMaster Guide 25 Appendix: MediMaster Guide MEDICARE What is Medicare? Medicare is a hospital insurance program in the U.S. that pays for inpatient hospital care, skilled nursing facility
Medicare Advantage HMO plans
2018 Medicare Advantage HMO plans Ally Rx (HMO SNP) Dual-eligible Special Needs Plan Affordable health coverage that looks out for you Y0117_MC-778-2824-C-09-17 approved Security Health Plan has you covered
HealthPartners MSHO (HMO SNP) Enrollment Form
HealthPartners MSHO (HMO SNP) Enrollment Form HealthPartners Enrollment Telephone Numbers 952-883-5050 or 877-713-8215. TTY for the hearing impaired at 711. The call is free. HealthPartners Member Services
Caring for Your Aging Parents
Caring for Your Aging Parents The first step you need to take is talking to your parents. Find out what their needs and wishes are. Don't try to care for your parents alone. Many local and national caregiver
Secure Blue (PPO) 2015 Evidence of Coverage. January 1 December 31, Your Medicare Health Benefits and Services Coverage as a Member of
Secure Blue (PPO) 2015 Evidence of Coverage January 1 December 31, 2015 Your Medicare Health Benefits and Services Coverage as a Member of Secure Blue (PPO) This booklet gives you the details about your
Annual Notice of Changes for 2018
SeniorHealth Basic and Plus Plans Combined Annual Notice of Change and Evidence of Coverage Contract Year 2018 Contra Costa Health Plan s SeniorHealth Plan, a Medicare Cost Plan offered by Contra Costa
Annual Notice of Changes for 2016
Health Alliance Medicare PPO 10 (PPO) offered by Health Alliance Connect, Inc. Annual Notice of Changes for 2016 You are currently enrolled as a member of Health Alliance Medicare PPO 10. Next year, there
SMP Complex Interactions Training Manual
SMP Complex Interactions Training Manual SMP Resource Center Table of Contents Acknowledgments... i About the SMP Resource Center... i Training Overview... ii Chapter 1: Complex Interactions and the SMP
Sentara MeadowView Terrace. Application for Admission
Sentara MeadowView Terrace Application for Admission P.O. Box 1600 184 Buffalo Road Clarksville, Virginia 23927 Admissions Coordinator Phone: (434) 374-4141 Fax: (434) 374-4491 Authorization Agreement
Your Guide to keeping your Kaiser Permanente Medicare health plan
Your Guide to keeping your Kaiser Permanente Medicare health plan KP Library: 42-35102677_Corbis_RF_LG_CMYK.psd Your Kaiser Permanente group Medicare health plan is changing and we re still here for you.
SMP Foundations Training Manual
SMP Foundations Training Manual SMP Resource Center Table of Contents Acknowledgements... i About the SMP Resource Center... i Training Overview... ii Updates Since August 2014...iii Chapter 1: SMP Program
Commonly Asked Medicaid Questions. 1. What is the difference between Medicaid and Medicare?
Commonly Asked Medicaid Questions 1. What is the difference between Medicaid and Medicare? Medicaid is a federal health program available to disabled individuals and seniors who are 65 or over. Eligibility
Select Medicare Advantage Dual Eligible Special Needs Plans in California
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244 DATE: September 15, 2014 TO: FROM: Select Medicare Advantage Dual Eligible
ADMISSION CONSENTS. 1. Yes No Automobile Medical or No Fault insurance due to an accident?
Patient Name: I.D. Number: Section A: Identifying Proper Payor ADMISSION CONSENTS Are services provided to you by Hospice reimbursements through health insurance other than Medicare due to one of the following
Introducing UPMC for You Advantage. A plan for those with Medicare and Medicaid eligibility.
Introducing UPMC for You Advantage. A plan for those with Medicare and Medicaid eligibility. We re here for you. It is such a comfort to have someone behind you who cares about your health and has the
Caring for Your Aging Parents
Emilio Vazquez SVP/CNB Wealth Management & Investment Executive INFINEX INVESTMENTS, INC. 1801 SouthWest 1st Street Miami, FL 33131 305-631-6410 emilio.vazquez@infinexgroup.com Caring for Your Aging Parents
Medicare & Medicare Supplemental Insurance (Medigap)
Elder Law Basics Medicare & Medicare Supplemental Insurance (Medigap) Steven A. Kass, Esq., CELA Law Office of Steven A. Kass, PC 105 Maxess Road, Suite N116 Melville, New York 11747 What is Medicare?
Authorization to Disclose Protected Health Information (PHI)
Authorization to Disclose Protected Health Information (PHI) Notice to Member: Completing this form will allow Health Net to share your health information with the person or group that you identify below.
B E I N G A H E A LT H L I T E R AT E C O N S U M E R
CHAPTER 3 B E I N G A H E A LT H L I T E R AT E C O N S U M E R LESSON 1 MAKING CONSUMER CHOICES 1. Define the term health consumer. Anyone who purchases or uses health products or services. 2. List 2
HAP Midwest MI Health Link Medicare-Medicaid Plan HMO Offered by HAP Midwest Health Plan, Inc Annual Notice of Changes
HAP Midwest MI Health Link Medicare-Medicaid Plan HMO Offered by HAP Midwest Health Plan, Inc. 2018 Annual Notice of Changes If you have questions, please call HAP Midwest MI Health Link at (888) 654-0706,
Services for Caregivers
1 Services for Caregivers Caregivers often find the task of caring for another person to be overwhelming. They often develop stress-related illnesses such as heart disease, hypertension, or ulcers. An
What is MyCare Ohio? A new coordinated approach to providing health care and long-term services and supports
An Overview What is MyCare Ohio? A new coordinated approach to providing health care and long-term services and supports What is MyCare Ohio? County LICKING Case/Category/Sequence 9999999999/MA A/01 Eligibility
Commonwealth Coordinated Care Enrollment Application Form
Exhibit 1: Model Medicare-Medicaid Individual Enrollment Request Form Referenced in 10.3, 30.1.1, 30.1.2, 30.2, 30.2.1 Keep a copy of this form for your records Commonwealth Coordinated Care Enrollment
UC SF Medical Group & Medical Center Active Contracts Report and LOA Training
UC SF Medical Group & Medical Center and LOA Training April 18, 2012 Agenda Letter of Agreement (LOA) Questions 1 2 Health Plans 3 Health Plans Column A contains all of the Health Plans that are contracted
arizona health net a better decision sm Putting you at the center of everything we do.
arizona health net a better decision sm Putting you at the center of everything we do. Nothing s more important than your health. When you re healthy, you want to stay healthy. When you re sick or have
PAC Waiver. eqhealth Solutions PAC Waiver Authorization Process
PAC Waiver eqhealth Solutions PAC Waiver Authorization Process January 2015 1 Purpose of Presentation Upon completion of the webinar, participants will be able to: 1. Prepare and submit PAC Waiver Requests
Guide to Acceptable Documentation for the National Verifier. National Verifier Acceptable Documentation Guidelines
Guide to Acceptable Documentation for the National Verifier National Verifier Acceptable TABLE OF CONTENTS Overview... 3 Proof of Eligibility... 3 Minimal criteria for acceptance... 3 Proof of Eligibility
ElderCareResourcesUSA CAREGIVER INFORMATION GUIDE
ElderCareResourcesUSA CAREGIVER INFORMATION GUIDE Caregiver Information Guide Caring for the people that once looked out for you is one tough job. At various times, youʼll have to act as an elder advocate,
Evidence of Coverage. Tufts Medicare Preferred HMO GIC (HMO) Employer Group. July 1 December 31, 2018
July 1 December 31, 2018 Evidence of Coverage Your Medicare Health Benefits and Services as a Member of: Tufts Medicare Preferred HMO GIC (HMO) Employer Group This booklet gives you the details about your
2019 Health Net Seniority Plus Amber I (HMO SNP) H0562: 055 Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco
2019 Health Net Seniority Plus Amber I (HMO SNP) H0562: 055 Fresno, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco and Tulare Counties, CA H0562_19_7837SB_055_M_Accepted
You recently called the Medicare Rights helpline for assistance with a denial from your Medicare private health plan.
Date: Dear Helpline Caller: The Medicare Rights Center is a national, nonprofit organization. We help older adults and people with disabilities with their Medicare problems. We support caregivers and train
Last Name: First Name: Middle Initial: City: State: Zip Code: City: State: Zip Code:
1240 South Loop Road Alameda, CA 94502 1-877-585-PLAN (7526) TTY 1-800-735-2929 8 a.m. - 8 p.m., 7 days a week www.alliancecompletecare.org I wish to enroll in the Alliance CompleteCare (HMO SNP) Medicare
See next page of this notice for more information.
1 Date:. Patient Name: Address: 68 Long Court, Suite 2C, Thousand Oaks, CA 91360 T- 805-777-7234 F- 805-777-0101 Notice of Medicare Non-Coverage Service Start/Admission Date: Patient ID Number: Provider/Facility:
In Solidarity, Paul Pecorale Second Vice President
Caregiving Guide Dear NYSUT Member: On behalf of the NYSUT officers and Board of Directors, we are proud to provide you with this publication, Caregiving Guide. In addition to providing information, referral
2018 MEMBER HANDBOOK
2018 MEMBER Ohio Molina Dual Options MyCare Ohio Medicare-Medicaid Plan Member Services (855) 665-4623, TTY/TDD: 711 Monday - Friday, 8 a.m. - 8 p.m., local time H5280_18_16509_0001_OHMMPMbrHbk Approved
PATIENT NOTICE. If you are already taking any of the above medications, your provider may want to talk to you about alternative treatments.
PATIENT NOTICE Our goal at is to provide quality medical care. Because of our concern for your health and well-being, there are certain types of medications we may not be able to prescribe to you. Examples
BioMarin Patient and Physician Support (BPPS) Enrollment Forms for KUVAN
BioMarin Patient and Physician Support (BPPS) Enrollment Forms for KUVAN Instructions for Completing Statement of Medical Necessity (SMN) and Prescription for KUVAN If you need assistance with the attached
Passport Advantage (HMO SNP) Model of Care Training (Providers)
Passport Advantage (HMO SNP) Model of Care Training (Providers) 2018 Passport Advantage (HMO SNP) is an HMO Special Needs plan with a Medicare contract and an agreement with the Kentucky Department for
HMO COMPLAINT - DATA PRACTICES NOTICE
HMO COMPLAINT - DATA PRACTICES NOTICE 1. The Minnesota Government Data Practices Act requires that we provide you with the following information: a) the purpose and intended use of the data you provide
All applications should be signed and dated in all designated areas of these forms.
2666 Riva Rd., Suite 400 Annapolis, MD 21401 Phone (410)-222-4464 TTY Users call via MD Relay 711 exjord00@aacounty.org Pamela A. Jordan Director July 1, 2017 Dear Applicant: Enclosed is an application
Effective: 12 October Hours:
Customer Support 94th Force Support Squadron 1342 Dobbins Place, Bldg 727, Room 1033 Dobbins ARB, GA 30069 Phone: 678-655-3835 Email: 94fss.fsmps.customerservice@us.af.mil Effective: 12 October 2017 Hours:
Evidence of Coverage
UCare Connect + Medicare Evidence of Coverage January 1 December 31, 2018 Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of UCare Connect + Medicare (HMO SNP) This
Commercial. Health Net. Group Retiree Plans. PPO Medicare Coordination of Benefits (COB) Pam White, We help members make informed decisions.
Commercial Health Net Group Retiree Plans PPO Medicare Coordination of Benefits (COB) Pam White, Health Net We help members make informed decisions. Health Net PPO Medicare Coordination of Benefits At
SPOUSE/GUARDIAN (If patient is married, give spouse information. If patient is a child, give parent information.)
Please Fill Out Completely: St. Mary s Women s Center 1000 Cowles Clinic Way, Suite D-300 Greensboro, GA 30642 762-243-3860 phone 762-243-3879 fax Patient s Last Name First Name MI Social Security Number
Outpatient Wellness Clinic
Outpatient Wellness Clinic Patient Name: Date of Birth: Address: Phone: Email: Emergency Contact: Relationship: Phone: What is the reason for the appointment? Who were you referred by? (Physician, agency/
CHI Mercy Health. Definitions
CHI Mercy Health Definitions If you have any questions about this notice, please contact the CHI Mercy Health s Privacy Office at (701) 845-6540 or 570 Chautauqua Blvd, Valley City ND 58072. Notice of
Dear Kaniksu Patient,
Dear Kaniksu Patient, Welcome to Kaniksu Health Services (KHS), a Community Health Center that provides quality and affordable medical, pediatric, dental, behavioral health and veteran care, regardless
South Carolina Respite Coalition (SCRC) Respite Voucher Program
South Carolina Respite Coalition (SCRC) Respite Voucher Program What is respite (res-pit)? Respite is short, temporary breaks from providing hands on care for a loved one with a significant disability,
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
ENROLLMENT, ELIGIBILITY AND DISENROLLMENT
ENROLLMENT ENROLLMENT, ELIGIBILITY AND DISENROLLMENT Enrollment in Washington Apple Health, Apple Health Fully Integrated Managed Care (FIMC) Medicaid Programs and Behavioral Health Services Only (BHSO)
Patient rights and responsibilities
Patient rights and responsibilities (Also: Billing FAQs) Legacy Health Patient Information: Rights/Responsibilities, It s OK to Ask, Billing FAQs 1 Patient rights and responsibilities Your hospital experience
Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
Section 2. Member Services
Section 2 Member Services i. Introduction 2 ii. Programs and Enrollment Information 7 iii. Identifying HPSM Members 8 iv. Member Eligibility 10 v. Identification Cards and Co-Payments 12 vi. PCP Selection
Introduction. Please tell us about yourself. 1. What is your zip code? 2. What is your race or ethnic group? (Select all that apply.
Introduction Evaluation of the Lifespan Respite Care Program IRB Protocol.: X091222018 Explanation of Procedures: Greetings! Please reply to questions about your experience with respite services as a family
HAP Midwest MI Health Link Medicare-Medicaid Plan Member Handbook
H9712_2016 MMP Handbook Accepted 12/12/2015 HAP Midwest MI Health Link Medicare-Medicaid Plan 2016 Member Handbook Effective: January 1, 2016 1 If you have questions, please call HAP Midwest MI Health
STAY HEALTHY ON THE GO
Traveling as a Kaiser Permanente member: VISITING MEMBER SERVICES STAY HEALTHY ON THE GO Getting the care you need while traveling in other Kaiser Permanente regions or Group Health Cooperative service
SPECIALIZED CARE FOR CHILDREN. Family Handbook. Core Program
SPECIALIZED CARE FOR CHILDREN Family Handbook Core Program Table of Contents Who We Are... 1 How We Help... 2 Is My Child Eligible?... 3 Care Coordination Tools... 4 ID Card... 5 When Should I Call My
A. Members Rights and Responsibilities
APPLIES TO: A. This policy applies to all IEHP Medi-Cal Members. POLICY: A. For the purpose of this policy, a Delegate is defined as a medical group, IPA or any contracted organization delegated to provide
ENROLLMENT, ELIGIBILITY AND DISENROLLMENT
ENROLLMENT ENROLLMENT, ELIGIBILITY AND DISENROLLMENT Enrollment in Washington Apple Health Medicaid Programs: Molina Healthcare Members are enrolled in a managed care health plan after the Health Care
CATHERINE FUND FINANCIAL AID APPLICATION March 2016
GUIDELINES/ QUALIFICATIONS FOR Please read all Guidelines, Policies and Procedures, and Instructions before completing application. You must meet all guidelines for your application to be considered. 1.
Assessment. SMP Foundations Training Kit. Table of Contents
SMP Foundations Training Kit Assessment Table of Contents Participant Assessment Questions and Answer Form Assessment Questions... 10 Pages Answer Form... 2 Pages Trainer s Resources Answer Key... 2 Pages
Standards for Success ROSS Data Elements
This shortcut assists ROSS Grantees to identify: Relevant data elements to collect; Questions for gathering information for the data element; and Possible response options. Participant Description 1 Person
2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1
2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1 Hawaii, Honolulu, Kalawao, Kauai and Maui counties MEDICAL COVERAGE Monthly Plan Premium $0 Calendar Year Out-Of-Pocket Maximum1 $1,200 Inpatient
Hospital Transitions: A Guide for Professionals.
Hospital Transitions: A Guide for Professionals 2017 www.medicarerights.org Medicare Rights Center The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure
FILE - HEALTH NET MEDICARE D USERS MANUAL
29 December, 2017 FILE - HEALTH NET MEDICARE D USERS MANUAL Document Filetype: PDF 217.07 KB 0 FILE - HEALTH NET MEDICARE D USERS MANUAL CONNECT SERVICE & SALES CENTERS One-on-one help, seven days a week
Mobile Mammo Registration Instructions
Mobile Mammo Registration Instructions 1. Call to schedule your appointment @ 239-936-4068 2. Fill out the following forms Note: All forms must be completed even if you were a previous patient on RRC Mobile
On the. Services for our Medicare health plan members who are visiting other Kaiser Permanente regions or Group Health Cooperative service areas
On the GO Services for our Medicare health plan members who are visiting other Kaiser Permanente regions or Group Health Cooperative service areas Y0043_N011615 accepted Travel WELL and get the care YOU
BioMarin Patient and Physician Support (BPPS) Enrollment Forms. for KUVAN
BioMarin Patient and Physician Support (BPPS) Enrollment Forms for KUVAN Instructions for Completing Statement of Medical Necessity (SMN) and Prescription for KUVAN If you need assistance with the attached