Advance Directives Information Sheet
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- Donna Blake
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1 What are Advance Directives? Advance Directives Information Sheet An Advance Health Care Directive (also known as an Advance Directive ) is a form that helps others give you the care you would want when you are not able to make decisions. Advance Directives will help make sure that your wishes about your health care are known. The form tells others how to make end-of-life care choices for you. The form also lets you name someone to act as your health care agent if you are not able to make decisions. An Advance Directive can give only a very few orders about your care, such as a name of someone you trust to make these choices for you, if you are not able to do so. It can also be very detailed and include the types of treatments you would accept or refuse to continue life. Some types of Advance Directives are only for certain situations, like organ or tissue donation, or your wishes not to be revived if your heart or breathing stops. The two most common types of Advance Directives are the Living Will and the Durable Power of Attorney for Health Care, which is sometimes called the Health Care Power of Attorney or Health Care Proxy. The Living Will explains your health care wishes in the case that you are terminally ill or permanently unconscious. The Durable Power of Attorney for Health Care allows you to name someone (an agent or proxy ) to make your health care decisions if the time comes when you are not able to do so. Why do I need to have an Advance Directive? You could have an accident or get sick. You might live with a mental or physical illness that leaves you unable to make decisions at times. Without an Advance Directive, those making decisions for you may not know what you want. Worse still, your family and friends could argue over the care you should get. Or they could disagree about who gets to make choices for you. Help your family and friends to help you: name an agent and tell your agent and family about your health care wishes. When should I make an Advance Directive? The best time to make an Advance Directive is before you need one! You need one before you become too sick to make your own choices about what medical care you want to take or refuse. It is good for anyone at any age to have an Advance Directive. Young people as well as older people should think about making an Advance Directive. It can be changed or cancelled at any time. It should be updated when needed or if you are diagnosed with a serious illness. Molina Dual Options Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. You can get this document for free in other formats, such as large print, braille, or audio. Call (877) , TTY/TDD: 711, Monday Friday, 8 a.m. to 8 p.m., local time. The call is free. The provider networks may change throughout the year. We will send you a notice before we make a change that affects you. H8046_NSR_18_MMP_1140_ILAHCAdvDirInfo 1/18/2018 1
2 What happens when I have an Advance Directive? If you have an Advance Directive and cannot make your own medical decisions, they will be made for you. These decisions will be based on the types of medical care you have chosen in your Advance Directive and/or by the person you chose as your agent or proxy for your health care choices. It is important to make sure that your family, health care providers, and others who might be called know that you have an Advance Directive and what is in it. They also need to have a copy of the Advance Directive so that it can be used in your treatment. At Molina Dual Options Medicare-Medicaid Plan, once you have told your doctor whether you have an Advance Directive or not, we require that your doctor record your decisions in your medical file. What important things should I know about Advance Directives? You have the right to allow or refuse any health care at any time. This is true even after you have signed an Advance Directive. It is true even if the Advance Directive gives different directions. You do not have to complete an Advance Directive. No one can force you to fill out an Advance Directive. It is against the law for anyone to force you to fill out a directive. You cannot be refused care or otherwise be discriminated against because you do not have an Advance Directive. You have the right to express your end-of-life care and other health care wishes. Advance Directives do not expire. An Advance Directive remains good until you change it. If you make a new Advance Directive, it cancels the old one. You have the right to have an agent make health care choices for you. Advance Directives are written to follow your state laws. What if I would like to learn more or fill out an Advance Directive? If you want to learn more or need to know how to get forms, you can go to the Molina Dual Options website. Also, our staff is trained about Advance Directive policies and can help you at Molina Dual Options community educational events, so please ask us if you have questions! You can get forms by going to the Caring Connections website: caringinfo.org and clicking on Download Your State Specific Advance Directive. You can get more facts on the Molina Dual Options website, and access forms via a link to the Caring Connections website, by following these steps: 1. Go to MolinaHealthcare.com/Duals 2. Go to Select State. Select the state you live in, and click Submit. 3. Go to Members at the top of the page. Select Medicare-Medicaid Alignment Initiative. 4. Click on Quality Service on the left-hand side under Medicare-Medicaid Alignment Initiative. 5. Click on Member Rights & Responsibilities under Quality Service. 6. Click on Advance Directives under Member Rights & Responsibilities. 7. Click on You can download your state s Advance Directives form on the Caring Connections website. 2
3 Molina Healthcare of Illinois (Molina) complies with all Federal civil rights laws that relate to healthcare services. Molina offers healthcare services to all members without regard to race, color, national origin, age, disability, or sex. Molina does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. This includes gender identity, pregnancy and sex stereotyping. To help you talk with us, Molina provides services free of charge: Aids and services to people with disabilities Skilled sign language interpreters Written material in other formats (large print, audio, accessible electronic formats, Braille) Language services to people who speak another language or have limited English skills o Skilled interpreters o Written material translated in your language o Material that is simply written in plain language If you need these services, contact Molina Member Services at (877) ; TTY/TDD: 711, Monday Friday, 8 a.m. to 8 p.m., local time. If you think that Molina failed to provide these services or treated you differently based on your race, color, national origin, age, disability, or sex, you can file a complaint. You can file a complaint in person, by mail, fax, or . If you need help writing your complaint, we will help you. Call our Civil Rights Coordinator at (866) , or TTY, 711. Mail your complaint to: Civil Rights Coordinator 200 Oceangate Long Beach, CA You can also your complaint to civil.rights@molinahealthcare.com. Or, fax your complaint to (562) You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Complaint forms are available at You can mail it to: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C You can also send it to a website through the Office for Civil Rights Complaint Portal, available at If you need help, call ; TTY
4 English ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). Chinese 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY:711). Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711). French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (ATS : 711). Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). Korean 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). Arabic ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم )رقم هاتف الصم والبكم: 711(. H8046_17_16035_471_ILMMPMultiLang Accepted 9/5/ MMP0916
5 Hindi ध य न द : यदद आप द द ब लत त आपक ललए म फ त म भ ष स यत स व ए उपलब ध (TTY: 711) पर क ल कर Italian ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: 711). Portugués ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (TTY: 711). French Creole ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: 711). Polish UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: 711). Japanese 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: 711 ) まで お電話にてご連絡ください Greek ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε (TTY: 711). Gujarati સ ચન : જ તમ ગ જર ત બ લત હ, ત નન:શ લ ક ભ ષ સહ ય સ વ ઓ તમ ર મ ટ ઉપલબ ધ છ. ફ ન કર (TTY: 711). Urdu خبردار: اگر آپ اردو بولتے ہیں تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں کال کريں (TTY: 711) H8046_17_16035_471_ILMMPMultiLang Accepted 9/5/ MMP0916
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