Welcome to Avera Health Plans

Transcription

1 Member Guide 1

2 1 Welcome to Avera Health Plans 2 In Your Neighborhood Benefits of Health Insurance Understanding Health Insurance Terms 3 Get on Track With Your Insurance Coverage 4-5 Member Resources 6-7 Digital Resources 8-9 Navigating Your Health Care Coverage Your Member Identification Card Member Portal: AveraHealthPlans.com Summary of Benefits and Coverage Explanation of Benefits (EOB) Keeping You Healthy Advocating for You Our Provider Network When You re Away From Home and Need Emergency Care Care Options Where to locate Important Health Coverage Information Other Insurance Needs Member Rights and Responsibilities

3 Welcome to Avera Health Plans At Avera Health Plans our wish for you is to live a healthy life so you can enjoy life s little pleasures. Our promise is to always be here for you. We are grateful for the confidence you place in our health insurance coverage and we want you to know we will do everything we can to meet your needs. Being an active participant in your overall health care will allow you to make informed decisions in controlling your health care costs. Throughout this booklet we included tips and resources to help you get the most out of your health insurance coverage. 1

4 In Your Neighborhood We have licensed agents and benefit counselors to assist you with enrollment or answer your health insurance questions. Aberdeen Mitchell Sioux Falls Black Hills Region Yankton 522 S. Arch 209 E. Fourth Ave S. Elmwood Call to set up 508 W. 23rd St MyAvera Benefits of Health Insurance No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and offers many other important benefits. Health insurance protects you from unexpected, high medical costs. You pay less for covered in-network health care, even before you meet your deductible. You get free preventive care to include wellness exams, vaccines; and preventive screenings like mammography and prostrate depending on your age. You may view a list of preventive services by logging into your member portal on our website. Some of our new plans have two additional free visits to your primary care physician your Summary of Benefits and Coverage will identify the free services. Understanding Health Insurance Terms The health insurance terms to the right can help you understand your benefits and how your health care expenses are calculated. Health Insurance Insight #29 Check ups are important Be sure to talk to your primary care provider and have regular checkups. Your provider is key to detecting concerns as early as possible. AveraHealthPlans.com Member Guide

5 Get on track with your insurance coverage Deductible What you will pay before your insurance will pay for covered services that aren t covered by co-pay or at 100 percent. In-Network/ Participating Provider: A health care facility, practitioner or provider who has a signed agreement with your health insurance company to provide services to members. Primary Care Provider: The first health care provider you should contact for treatment, typically includes family practitioners, internists, OB/GYN providers and pediatricians. Coinsurance Money you pay for covered health services, calculated as a percentage, for example, the insurance pays 80 percent and you pay 20 percent of the bill. You pay the coinsurance percentage after reaching your deductible until you reach the out-of-pocket maximum. Premium Monthly amount that you pay for your health insurance plan. Premium does not figure into the out-of-pocket maximum. Co-Pay A fixed amount (for example, $35), that you pay for a covered health care service, such as a clinic or urgent care visit. Your co-pay can vary by the type of service, and whether you see a primary care provider or specialist. Out-of-Pocket Maximum Combines co-pays, deductibles and coinsurance. After you reach your out-of-pocket maximum for an individual or family, you stop paying and insurance takes over for the remainder of your deductible year. 3

6 Member Resources Our Service Center Avera Health Plans can connect you with the right people to assist you through your health care. After you become a member, you can call or us with your inquiry, and we will do our best to help you. For members requiring language assistance, our Service Center offers free translation services in more than 100 languages to help you receive information about benefits and how to access medical services. If members are hearing impaired, TDD/TTY services are available by calling 711 (or from outside South Dakota). Request the State Relay Services to connect you to our Service Center number listed above /7 Nurse Line Call our 24-Hour Nurse Line at At no cost to you, experienced registered nurses can answer your questions, offer support and help you decide whether to go to the emergency room, an after-hours clinic, contact your provider or use home care Life Resource For members who have questions that aren t related to health care needs, this program is available 24/7 to provide non-medical referrals for a number of topics ranging from food and housing services to education, employment resources and legal services. Contact Life Resource at or LifeResource@AveraHealthPlans.com for more information.

7 Resources for Chronic and Complex Conditions Managing a chronic disease or complex illness can sometimes feel like a full-time job. Avera Health Plans experts are available through our case management and disease management programs and are ready to help! These programs are available at no cost to you and can help improve your quality of life and reduce medical expenses. Specially trained nurses work closely with you and your providers to ensure appropriate, timely and cost-effective medical services. We also provide information about care options to help patients make informed decisions. We help patients manage care for conditions such as: Heart disease Diabetes Cancer Transplant Trauma Asthma COPD For more information on our care management programs, call toll-free at We also might ask you if you re interested based on your claims information, or your provider may refer you My Recovery Chemical Dependency Treatment Program My Recovery Chemical Dependency Treatment Program is a benefit exclusively available for Avera Health Plans members. The program was created using a successful model that focuses on a short-term inpatient stay complemented with an outpatient rehabilitation program under the direction of highly specialized physicians and counselors. Our program includes a three- to seven-day inpatient stay for a member who may need detoxification. This is followed with an eight-week program of outpatient counseling. The outpatient program includes three sessions per week over an eight-week timeframe and is currently designed for members who live within a 90-mile radius of Sioux Falls. To see if you qualify for coverage or to find out how to enroll in the program, call our Service Center. 5

8 Digital Resources To provide quick access to your personal health information, Avera Health Plans has conveniently created multiple digital resources for members to use. Member Portal After you enroll and receive your member ID card(s), you can register to access your online resources. We have a secure website so you can find the resources you need when you need them. This easy-to-navigate portal gives you access to the following resources: My Benefits My Pharmacy My Claims/Explanation of Benefits My 365 Your online personal wellness guide My Provider Directory AveraChart AveraChart is a free, secure, easy way for Avera patients to access their health care information, communicate with their care team, and become a more active partner in their own health care. We recommend members sign up for AveraChart at Avera.org/averachart MyHealthPlan Mobile App We recommend members download MyHealthPlan from the Android market or Apple app store. Find in-network providers, make monthly payments and access your claims and year-to-date balances, all from the convenience of your phone. AveraHealthPlans.com Member Guide

9 Your Online Personal Health Suite My 365 gives members access to information and tools developed by health experts to help make changes toward a healthy lifestyle. My 365 includes the following online tools: Wellness assessment Personal health record Healthy living programs Preventive reminders Daily health news feeds Monthly online seminars Progress trackers AveraNow AveraNow is an online video visit program designed to conveniently connect you with an Avera provider. You can connect through your smartphone, tablet or laptop. Avera Health Plans is providing this program at no charge for most members. Members can access their coupon code by logging into their Member Portal. This virtual program treats simple illnesses such as pink eye, rashes and colds. Limitations apply. Visit AveraHealthPlans.com for more details and click on the AveraNow link to learn more. NOTE: As of Jan. 1, 2016, the IRS has not issued guidance about whether the value of telehealth programs such as AveraNow is a significant medical benefit. Those members with a high deductible, HSA-eligible plan should consult their tax advisor on the use of AveraNow for possible tax implications. 7

10 Navigating Your Health Care Coverage Preauthorization of Health Care Services Do I need approval before having a service or procedure done? In some cases, yes. We require a preauthorization when specific services, supplies and procedures are approved by us BEFORE the services are received. You can access a complete list of services and medical equipment that require preauthorizations online by logging into your member portal or call our Service Center for a copy of the list. Note: Preauthorization does not guarantee benefits. The preauthorization list is subject to change. Guidelines to Support Quality Care Preauthorization Process To help ensure that our members receive quality health care in an appropriate treatment setting, Avera Health Plans utilization management program uses medical necessity guidelines in evaluating requests for coverage. The following guidelines are used by Avera Health Plans: Your provider must call or fax us if you need services requiring preauthorization. Our medical management team will review the request and a letter will be mailed to you and your provider with the approval or reason for denial. This process is completed within 15 calendar days. For approved services, the letter will list the services that have been approved (for example, office visit only or office visit and lab tests). Please read the letter carefully so you know what services your provider has been authorized to perform. Avera Health Plans chief medical officer is available by phone to discuss coverage determinations based on medical necessity. Utilization management decisionmaking is based on medical necessity, applicable coverage guidelines, and appropriateness of care and service. Avera Health Plans does not compensate individuals who conduct utilization review for issuing denials of coverage, nor does it provide financial incentives for utilization management decision-makers to encourage denials of appropriate coverage. Financial incentives for utilization review do not encourage decisions that result in underutilization. AveraHealthPlans.com Member Guide

11 Your Member Identification Card You and each of your covered dependents (spouse and/or children) will receive a member identification (ID) card. You must show your member ID card whenever you need health care services. Carry your member ID card with you at all times and become familiar with the information on the card. Phone numbers and coverage shown on this sample member ID card may vary from the information listed on your member ID card. 1. The subscriber (or policyholder) is the person who carries the health insurance plan. The subscriber may have dependents (spouse and/or children). Subscribers, policyholders and dependents are also referred to as members of the health plan. 2. The subscriber (or policyholder) and group identification numbers are used by your provider to identify you and your plan of coverage. 3. Your member identification number. Every member has his/her own number. 4. The phone number of your pharmacy benefit manager. The back of your member ID card provides other important information: Out-of-Area Residence Dependent In-network benefits are available to dependents who are currently enrolled with Avera Health Plans and who reside outside of the Avera Health Plans network coverage area for more than 90 consecutive days. ELIGIBILITY REQUIREMENTS: 1. Your dependent must be eligible and enrolled with Avera Health Plans. 2. Your dependent must reside outside the Avera Health Plans network coverage area for more than 90 consecutive days. 3. You must complete the Out-of-Area Residence Dependent form and submit it to Avera Health Plans. This form can be found by logging into the Member Portal at AveraHealthPlans.com. In-network coverage will be effective on the date we receive this completed form. Verify your outside network provider by looking on the back of your Member ID card and visiting the corresponding website for the most up-to-date information regarding a provider s participating status. Please note providers may not be participating providers at all locations where they practice. Therefore, it is important to verify the provider s practice and address on the website. Our Service Center phone number Our website address The address where claims should be sent Steps to find a participating provider 9

12 Member Portal: AveraHealthPlans.com After you enroll and receive your member ID card(s), you can register to access your online resources. We have a secure website so you can find the resources you need when you need them. Or, use the free MyHealthPlan mobile app. You Must Register the First Time 1. Click Login from our home page. 2. Under the login box, click on Sign Up to create your account. 3. Make note of the username and password you created on the registration page. 4. You can review your information immediately. After You ve Registered You will be asked to enter your username and password. After you log in, you will find the following tabs across the top of the screen: Home My Benefits My Pharmacy My Claims/EOB My 365 My Provider Directory Frequently Asked Questions Dependents Over Age 18 Dependents can now stay on your health plan until age 26. However, for dependents 18 and older (including spouse), you will not be able to access their claims or Explanation of Benefits unless they complete and sign the Authorization for Access of Health Information consent form. The Forms link can be found on the My Benefits screen after you log in.

13 My Pharmacy We provide coverage for prescription medications through a pharmacy benefit manager. The pharmacy benefit manager contracts with pharmacies throughout the country to provide prescription services to our members. We work together to provide access to medications while working to control pharmacy costs. To get the most from your pharmacy benefits, use generic medications whenever possible and bring your Drug Formulary, or list, to your provider appointment. Choose a pharmacy that participates with the Avera Health Plans pharmacy benefit manager. To verify if your pharmacy participates: 1. Visit our website AveraHealthPlans.com 2. Click Login and enter Username and Password 3. Click the My Pharmacy tab and then the RxAdvance Locator link. Show your member ID card at the pharmacy each time you have a prescription filled. If your plan has a co-pay, pay the pharmacy your co-pay for the prescription. If the retail cost is less than the co-pay, you pay the retail amount for the medication. My Provider Directory In-Network and Out-of-Network Benefits To help manage health care costs, our in-network providers offer discounts on services and medical procedures. When you receive medical care from physicians, hospitals and other health care providers participating in the Avera Health Plans network, you receive in-network benefits and save money. Out-of-network providers are physicians, hospitals and health care providers who do not participate in the Avera Health Plans network. You have the option to use an out-of-network provider. If you receive medical care from an out-of-network provider, you receive out-ofnetwork benefits and will pay more for those services. You can search for participating providers on our website AveraHealthPlans.com and click Login. After you log in, click My Provider Directory. This takes you to a directory of providers specific to your plan. You can also access this information through our mobile app. Pharmacy@AveraHealthPlans.com with questions about your medications. NOTE: On the My Pharmacy page, you will also find the Avera Drug Formulary and search functions to identify approved prescription medications. These lists are updated periodically. Health Insurance Insight #33 Be Proactive with Heart Health Aspirin isn t just a painkiller; it also thins blood, which can help prevent blood clots from forming. Ask your doctor: Would I benefit from aspirin? Are there side effects? How long should I take it? Will it interfere with other medications? 11

14 Summary of Benefits and Coverage Certificate of Coverage or Individual Health Insurance Policy Your policy is referred to as the Certificate of Coverage for members with group insurance or Individual Health Insurance Policy for Avera MyPlan members. Where can I find the details to my health plan? You can access your Certificate of Coverage (or policy) and a list of specific services and procedures that are covered or not covered by your health plan on our website after you log in. The link is found on the My Benefits page along with other resources. These documents explain the details about what services are covered and what services are not covered by your specific plan. You will find a listing of what services or procedures you need to have authorized in advance, also known as preauthorization. Your Summary of Benefits and Coverage identifies what your costs (co-pay, coinsurance, deductible and out-of-pocket maximums) will be and provides other benefit-related information. Where can I find my Summary of Benefits and Coverage? You can access your Summary of Benefits and Coverage at AveraHealthPlans.com, select Login. After you log in, you will see the link (in green) located to the right of your name. For individual policyholders, you can make a payment online for your monthly premium. AveraHealthPlans.com Member Guide

15 Explanation of Benefits (EOB) The Explanation of Benefits (EOB) provides information about how your claim was processed; it is not a bill or an invoice. Your claims and EOBs can be viewed on our website after Avera Health Plans receives the claim from your provider. To view your Explanation of Benefits, go to AveraHealthPlans.com and select Login. After you log in, you can view the most recent claims processed on the Home page or you can then click My Claims/EOB to search and view claims processed by us. Your EOB also shows you any amount that you may owe. The Home page will also give you year-to-date balances of your deductible(s) for your in- and out-of-network usage. You can go paperless by requesting that your EOBs no longer get mailed to you and you will receive an when the EOB is available online. Your claims and deductible balances can also be viewed on our mobile app MyHealthPlan. 13

16 Keeping You Healthy We are always committed to helping you achieve your goals when it comes to your wellness. We can design a program to fit your individual needs and schedule. Our wellness coach will provide the support and motivation to help you lead a healthy lifestyle. Coaching will consist of: Health risk assessment to determine program development Phone consultations based on individual needs Some examples of members health goals are: Managing diabetes Eating healthier Quitting smoking Losing weight Decreasing allergy triggers Having a healthy pregnancy Ongoing support and program development based on individual progress Tools and resources to support you along with learning more about our online wellness resource with My 365 WellnessCoach@AveraHealthPlans.com if you are interested in connecting with our wellness coach. AveraHealthPlans.com Member Guide

17 Advocating for You To learn more about our care management nurses or wellness coach services: CALL our Service Center at or toll-free at , 8 a.m. to 5 p.m. CT, Monday through Friday. Service@AveraHealthPlans.com or WellnessCoach@AveraHealthPlans.com. Utilization Management decision making is based only on appropriateness of care and service and existence of coverage. Avera Health Plans does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization. When you or a family member are diagnosed with a condition or need major surgery, nurses are available at Avera Health Plans to answer your questions. Our care management nurses are registered nurses and patient advocates who are available to help you with the following: Offer assistance to navigate the health care system Assist with care transitions, finding a physician or specific specialist within your provider network Help with communication between you and your provider Provide education about wellness, preventive services, health conditions, community resources, insurance benefits and any other concerns you may have Collaborate with your primary care doctor Our goal is to provide you the tools, resources and attention you need to make a difference in your health. You can focus on being well and can always count on us to be a link between you, your provider and your community. Health Insurance Insight #31 Tobacco Isn t Healthy. Tobacco has a range of long-term health consequences. Lucky for you, we have a wellness coach who can help you quit smoking for good. Develop strategies to stay focused and motivated to quit Identify challenges and strategies to overcome them Schedule a consultation by calling

18 Our Provider Network Because we are part of South Dakota s largest health care system Avera Health our members benefit with low premiums and affordable benefits. Our network also includes Rapid City Regional Health System and more. Avera Health Plans is supported by a high-quality network of providers throughout South Dakota, southwestern Minnesota, northwestern Iowa and northeastern Nebraska. Our network includes: 92 hospitals > 2,000 primary care providers 4,300 specialists and other health care professionals Our goal is to contract with providers who will ensure all members receive quality service and value rates no matter where they live. Not only does Avera do health care right, our trained and experienced health plans staff knows health insurance. Extended coverage also is available outside our service area for members and or dependent(s) who reside elsewhere. Members who live in the Avera service area have access to: More than 300 locations in 100 communities 19 birthing centers with access to a Level IIIB NICU facility in Sioux Falls 32 hospitals equipped with emergency services More than 17 urgent care or after-hours convenience clinics throughout the region Six Avera Cancer Institute centers connecting you to the latest treatments and technology o Including a genomic medicine program 60 medical specialties, many of which are connected to rural clinics through Avera ecare. Avera ecare is the largest, most comprehensive telehealth network in the nation. A nationally ranked heart program that has more than 25 specialists traveling to almost 230 locations to provide care 16

19 When You re Away From Home and Need Emergency Care If you are traveling outside our service area and need immediate medical care, please present your Avera Health Plans member ID card to the physician or hospital caring for you and identify yourself as an Avera Health Plans member. Instructions for billing and notifying us are on the back of your card. When it is medically appropriate, arrangements may be made for you to be transferred to the care of an Avera Health Plans participating provider in order for you to receive benefits at the lowest cost using in-network services. Note: You may be required to pay for medical services at the time they are provided. 17

20 Care Options You have a wide range of care options at different price points. Make sure you pair your specific needs to the best service option to save on costs. NOTE: When you have the option, please choose an in-network hospital when going to the emergency room to keep your expenses to a minimum. Nurse Hotline Registered nurses answer your health questions, including if you need immediate care. FREE AveraNow * $ 24/7 provider access via your smartphone, laptop or tablet. Simple illnesses like colds, fevers, pink eye, sinus infections. $49 per visit. Limitations apply. See page 7 for details. Physician s Office $$ Care during normal business hours: sickness, injury, preventive services. Urgent Care Clinic $$$ The same medical services as a physician s office. After normal business hours. Emergency Room $$$$ The most serious or life-threating medical conditions: chest pain, passing out, severe burns, etc. AveraHealthPlans.com Member Guide

21 Where to Locate Important Health Coverage Information Where to Locate Important Health Coverage Information The following resources are located online after you log into the member portal: Certificate (Evidence) of Coverage Certificate (Evidence) Member of Coverage Guide Member Guide Summary of Benefits Summary and of Coverage Benefits and Coverage or Individual Insurance Policy or Individual Insurance Policy Benefits and services How to obtain language Co-payments and other charges Benefits and services included in, and excluded How to obtain language and TTY assistance Co-payments and for other which charges members are included in, and excluded from, coverage and TTY assistance for which members responsible are from, coverage responsible Pharmaceutical management How to obtain care after Benefit restrictions that apply to procedures normal office hours services obtained out-of-network Pharmaceutical management How to obtain care after Benefit restrictions that apply to procedures How to submit a claim normal for covered office hours How to obtain services emergency obtained out-of-network services care, including when to The three documents can be found How to submit a claim for covered How to obtain emergency use 911 services on our website after clicking "Member services care, including when to The three documents Login" can at be AveraHealthPlans.com. found How to obtain information use 911 about services How to obtain care and practitioners who participate in coverage when on our travelling website after clicking "Member The Member Login hosts many of the Avera Health Plans network outside of the Login" network at AveraHealthPlans.com. How to obtain information about How to obtain care and your personal health insurance plan materials. You may also request copies practitioners who participate How in to obtain primary coverage care services when travelling How to access The our Member mobile Login of hosts the documents many of by contacting our the Avera Health Plans network outside of the network apps and what your is personal available health Service insurance Center. plan How to obtain specialty care, on your secured member materials. You may also request copies How to obtain primary care behavioral services health care How and to hospital access our mobile portal website. services of the documents by contacting our apps and what is available Service Center. How to obtain specialty care, How to obtain care on and your coverage secured member behavioral health care and when hospital living outside portal of the website. network FREE MyHealthPlan Mobile App services How to voice a complaint Our mobile app allows you to access to your claims, How to access Case How to obtain care and coverage pharmacy information, make a monthly premium How to appeal a decision Management that and payment and more on your smart phone. when living outside of the adversely network affects coverage, Disease benefits Management or the member's relationship with To download, search for MyHealthPlan or use the How to voice a complaint services the health plan quick response (QR) codes located on the bottom of the page. How to appeal a decision that How Avera Health Affirmative Plans evaluates Statement Note: Your username and password will be the same adversely affects coverage, new benefits technology for regarding inclusion as Utilization a as you would use to log in to your member portal. covered benefit or the member's relationship with Management Decisions Apple download: Google download: the health plan Protected Health Information (PHI) Use and Disclosure Member Including: Rights and How Avera Health Plans evaluates Avera Health Plans' Responsibilities routine use new technology for inclusion and as disclosures a of PHI covered benefit Use of authorizations Access to PHI Protected Health Information Internal (PHI) protection of oral, written Use and Disclosure Including: and electronic PHI across Avera Protection of information disclosed Avera Health Plans' routine use to plan sponsors or employers and disclosures of PHI Use of authorizations Access to PHI Internal protection of oral, written and electronic PHI across Avera Protection of information disclosed to plan sponsors or employers 19

22 Other Insurance Needs Individual Health Insurance Insurance is available for those not eligible for group health coverage. Our website provides online quotes and information regarding our rates and plan options for individual health insurance coverage. Visit AveraHealthPlans.com to shop for our health insurance plans for you and/or your family. Medicare Supplement Insurance Do you know someone who needs a Medicare Supplement Insurance plan? Avera Health Plans has coverage to help you pay for those medical expenses not fully covered by Medicare. Learn more by visiting AveraHealthPlans.com. You can also call or toll-free at , 8 a.m. to 5 p.m. CT, Monday through Friday. Employer Group Health Insurance Employers with two or more benefits-eligible employees have the flexibility to create an insurance package that complements their company s budget. We provide an innovative quoting model to choose benefits that are affordable and essential to your group. The employer will select between the several services and benefit options to determine the premium. To learn more about plans available to small or large groups, contact your agent or call and ask for our sales manager. AveraHealthPlans.com Member Guide

23 Member Rights and Responsibilities You have the right to: Information about your plan, its services, participating providers and other health care professionals providing care. Be treated with respect and recognition of dignity and right to privacy. Participate in decisions with your providers about your health care. You should receive enough information to make an informed decision before receiving any treatment. The information should include the specific procedures of treatment, medical alternatives and associated risks, regardless of the cost or benefits coverage. Voice and discuss complaints and appeals about the organization or the care of its providers. Make recommendations regarding our Member Rights and Responsibilities policy. Not be discriminated against because of age, gender, cultural background, educational or economic status, religious or sexual orientation, or mental or physical disability. Not have genetic information used to determine eligibility coverage, underwriting or premiums, or to have genetic information used as a pre-existing condition. Timely, proper medical care without discrimination of any kind, regardless of health status or condition. Receive advice or assistance in a prompt, courteous and responsible manner. Confidentiality. We will protect your medical records and personal information. Information about the diagnosis, treatment and expected outcomes in terms that you understand. If your provider determines that the information could be harmful to you, the information will be given to a person designated by you or someone with legal authority. Have a guardian, next of kin or legally authorized person exercise rights on your behalf if a edical condition makes you incapable of understanding or exercising your rights. Designate any primary care provider who participates in our network and who is available to accept you or your family members. Designate a pediatrician as the primary care provider for your children. Obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology without a referral. You have the responsibility to: Confirm your provider is participating in our network before every service in order to receive the best benefit possible. Treat all Avera Health Plans and provider staff and other members with respect and courtesy. Carry your Avera Health Plans member ID card at all times and never permit anyone else to use it. Pay your deductible or coinsurance promptly. Review and follow your Certificate (Evidence) of Coverage or Individual Health Insurance Policy to receive your best benefits. Promptly notify us of any changes such as address changes or changes in family status due to marriage, birth, adoption or divorce. Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care. Follow your provider s instructions about for care that you have agreed to with your providers. Understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible. 21

24 AveraHealthPlans.com Toll-Free: AVHP-5819 (11/15)