2 MY BENEFITS GUIDE MCDTX_17_57630 09182017 Valid September 1, 2017 to February 28, 2018
Table of contents 4-5 Introduction Important phone numbers My Cigna-HealthSpring benefits 10-11 Members with Medicaid only Extra vision services Extra dental services $30 gift card for Good Health Rewards 6-9 All Members Fitness benefit 24-hour Nurse Line $10 monthly allowance for over-the-counter health products Emergency response services Respite care services Extra help getting a ride Reaching tool Clip-on lamp NEW! Lumbar support pillow Vinyl gloves NEW! Personal fan 12-13 Pregnant Members or new mothers Extra dental services Pregnancy book Home health visit 3
Important phone numbers Member Services Monday to Friday 8 a.m. to 5 p.m. Central Time Service Coordination 1-877-725-2688 Monday to Friday 8 a.m. to 5 p.m. Central Time 24-hour Nurse Line 1-855-418-4552 24 hours a day 7 days a week Behavioral Health and Substance Abuse 1-877-725-2539 Monday to Friday 8 a.m. to 5 p.m. Central Time Dental care 1-855-418-1628 Monday to Friday 7 a.m. to 8 p.m. Central Time Vision care 1-800-879-6901 Monday to Friday 7 a.m. to 7 p.m. Central Time Transportation 1-877-725-2688 Monday to Friday 8 a.m. to 5 p.m. Central Time 4
My Cigna-HealthSpring benefits Cigna-HealthSpring STAR+PLUS Members GET FREE SERVICES that are not covered by basic Medicaid. Review this booklet to learn about your benefits. Not every service may be listed. For more information, you can: 1 Review your Member Handbook. 2 Call Member Services toll-free Monday to Friday, 8 a.m. to 5 p.m. Central Time. 3 Go to STARPLUS.MyCignaHealthSpring.com/STARPLUShandbook. 5
ALL MEMBERS The following benefits are available to all Cigna-HealthSpring STAR+PLUS Members. Fitness benefit You can choose 1 of the following: Fitness facility membership, or 2 home fitness kits such as: Exercise Walking Pilates Tai Chi Stress Management and more Fitness facilities must be in-network. If you need help you may bring a caregiver to fitness facility. You can change fitness facilities once a month. Home fitness kits are for those who do not join a fitness facility. You can get 2 fitness kits yearly. Call to find a fitness center or join in the Home Fitness program: 1-866-780-8545 (TTY/TTD 1-877-710-2746) Monday to Friday, 7 a.m. to 10 p.m. Central Time 24-hour Nurse Line You can call to talk to a nurse 24 hours a day, 365 days a year. You can get health information and advice anytime day or night. Call the 24-hour Nurse Line at: 1-855-418-4552 (TTY: 7-1-1) 6
$10 monthly allowance for over-the-counter health products You can get $10 every month to use toward your over-the-counter (OTC) health products. You will receive an OTC catalog that lists items such as: Anti-itch lotions and creams Cold, flu, decongestant and sinus relief Dental and denture care First aid and medical supplies Foot care Sleeping aids Vitamins and minerals Wart remover and more Unused dollars rollover month to month but must be used by August 31, 2018. To place an order call: 1-866-575-3744 Emergency Response Services Respite care services You can get 24 hours of respite care to help your family or other unpaid caregivers every 12 months. If you are a Waiver Member you are not eligible for respite care. Extra help getting a ride You can get a ride to your doctor and other medical visits. Service Coordinators will arrange for transportation services when State transportation services are unavailable. You must call at least 2 days before appointment to schedule transportation. Call Service Coordination at: 1-877-725-2688 (TTY: 7-1-1) You can get a medical Emergency Response System in your home. 7
ALL MEMBERS (continued) Reaching tool The following benefits are available to all Cigna-HealthSpring STAR+PLUS Members. You can get a reaching tool every 12 months. Clip-on lamp You can get a lamp every 12 months. 8
NEW! Lumbar support pillow You can get a pillow every 12 months. NEW! Personal fan You can get a personal fan every 12 months. Vinyl gloves You can get a box of vinyl gloves every month. 9
MEMBERS WITH MEDICAID ONLY The following benefits are available to Cigna-HealthSpring STAR+PLUS Medicaid Members only. Extra vision services If you are age 21 and older covered only by Medicaid you can get a vision services that include: 1 eye exam 1 pair of glasses Up to $100 for enhanced frame selection every 12 months $100 allowance does not apply to contact lenses, add-ons, replacement eyewear or sunglasses. Extra dental services If you are age 21 and older covered only by Medicaid you can get dental services such as: Oral examinations X-rays Cleaning Restorative services Simple extractions A $500 annual maximum limit applies to all services. You can visit a participating dentist to get services. A primary doctor referral is not needed. 10
$30 gift card for Good Health Rewards If you are covered by only Medicaid you can get a $30 gift card for getting your annual well visit with certain tests, labs or immunizations. Limit 1 gift card per year.
PREGNANT MEMBERS OR NEW MOTHERS The following benefits are available to Cigna-HealthSpring STAR+PLUS Members who are pregnant or new mothers. Extra dental services If you are pregnant covered only by Medicaid you can get dental services such as: Oral examinations X-rays Cleaning Restorative services Simple extractions A $500 annual maximum limit applies to all services. You can visit a participating dentist directly to get services. A primary doctor referral is not needed. Pregnancy book If you are pregnant you can get a book to help you understand pregnancy. Limit 1 book per year. 12
Home health visit If you are a new mother covered only by Medicaid you can get the following: Self-care and baby-care information 1 home health care visit within a 12-month period
Notice of Nondiscrimination: Discrimination is Against the Law Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna-HealthSpring does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna-HealthSpring: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Member Services. If you believe that Cigna-HealthSpring has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Cigna-HealthSpring Attention: Appeals, Complaints, and Grievances Department P.O. Box 211088 Bedford, Texas 76095 7 days a week 8 a.m. to 8 p.m. Central Time Fax: 877-809-0783 You can file a grievance in writing by mail or fax. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal. hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http:// www.hhs.gov/ocr/office/file/index.html. 14
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16 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2017 Cigna