HUSKY Health Program Member Handbook HUSKY A, HUSKY C, and HUSKY D

Size: px
Start display at page:

Download "HUSKY Health Program Member Handbook HUSKY A, HUSKY C, and HUSKY D"

Transcription

1 HUSKY Health Program Member Handbook HUSKY A, HUSKY C, and HUSKY D Revised 8/3/ Member Services

2 TABLE OF CONTENTS IMPORTANT TELEPHONE NUMBERS Page 1 CHANGES TO YOUR INFORMATION Page 1 STATE DEPARTMENT OF SOCIAL SERVICES (DSS) REGIONAL OFFICES Page 2 WELCOME TO THE HUSKY HEALTH PROGRAM! Page 3 Getting the Most Out of Your Membership Page 3 HOW THE HUSKY HEALTH PROGRAM WORKS FOR YOU Page 3 Our Website Page 3 WELCOME MEMBERS Page Page 4 MY HEALTH CARE Secure Member Portal Page 4 Secure Provider Portal Page 5 Member ID Card Page 5 Nurse Helpline Page 6 Translation and Interpretation Services Page 6 HOW TO ACCESS YOUR HEALTH CARE SERVICES Page 7 HUSKY Health Providers Page 7 Choosing your Primary Care Provider (PCP) Page 7 Specialists Page 9 Second Opinions Page 9 HUSKY BENEFITS Page 9 EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT) SERVICES Page 10 COVERED SERVICES Page 12 Ambulatory Surgery Page 12 Ambulance Page 12 Behavioral Health Services Page 12 Chiropractor Page 13 Chronic Disease Hospital Page 13 Clinic Services Page 14 Dental Services Page 14 Dialysis Page 15 Durable Medical Equipment (DME) Page 15 Emergency Care Page 15 Eye/Vision Care Page 16 Family Planning Page 16 Gender Reassignment Surgery Page 17 Hearing Aids & Exams (Audiologists) Page 17 Home Health Care Services Page 17 Hospice Page 17 Hospital Services Page 18 Independent Therapy Page 18 Intermediate Care Facility/Mental Retardation (ICF/MR) Page 19 Laboratory Work Page 19 Maternity Page 19 Medical Surgical Supplies Page 19 Naturopaths Page 20 Nursing Facilities Page 20 Revised 8/3/2015 i Member Services

3 Orthotic & Prosthetic Devices Page 20 Out-of-State Coverage Page 21 Oxygen Page 21 Parenteral/Enteral Supplies Page 21 Pharmacy Services Page 21 Physician Services Page 23 Podiatry Page 23 Radiology Services Page 23 Rehabilitation Clinic Page 23 Smoking & Tobacco Cessation Page 24 Transportation (Non-Emergency Medical) Page 24 SERVICES THAT ARE NOT COVERED Page 26 GETTING THE RIGHT CARE, AT THE RIGHT TIME, AND AT THE RIGHT PLACE Page 27 Preventive/Routine Care Page 27 Urgent Care Page 27 Emergency Care Page 28 INTENSIVE CARE MANAGEMENT (ICM) Page 28 SPECIALIZED PROGRAMS Page 30 Transplant Care Management Page 30 Healthy Beginnings Maternity Program Page 30 Healthy Airways a program for members with Asthma Page 30 Living Well with Sickle Cell a program for members with Sickle Cell Disease Page 30 Healthy Living with Diabetes a program for members with Diabetes Page 31 COMMUNITY RESOURCES Page 31 Women, Infants, and Children (WIC) Nutrition Program Page 31 Healthy Start Page 31 Nurturing Families Page 31 Birth to Three Page 32 HUSKY InfoLine (211) Page 32 School-Based Child Health Services Page 32 Educational Health Materials Available to Members Page 32 MEMBER RIGHTS AND RESPONSIBILITIES Page 33 Your Rights Page 33 Your Responsibilities Page 33 ADVANCE DIRECTIVES Page 34 GRIEVANCES, QUALITY OF CARE, AND ADVERSE INCIDENT REPORTING Page 34 PRIVACY Page 36 APPEALS Page 37 Expedited (Rushed) Review Page 38 MEMBER SATISFACTION SURVEY Page 38 RENEWALS FOR HUSKY C MEMBERS Page 39 RENEWALS FOR HUSKY A AND D MEMBERS Page 39 MEMBER BASIC INFORMATION FACT SHEET Page 40 Revised 8/3/2015 ii Member Services

4 IMPORTANT TELEPHONE NUMBERS Services Phone Number HUSKY Health Program Member Services Monday Friday: 8:00 a.m. to 6:00 p.m. TTY: 711 Transportation Services Provided by LogistiCare Monday Friday: 7:00 a.m. to 6:00 p.m. Behavioral Health Services CT Behavioral Health Partnership: CT BHP TTY: 711 Monday Friday: 9:00 a.m. to 7:00 p.m. Dental Services CT Dental Health Partnership: CTDHP TTY: 711 Monday Friday: 8:00 a.m. to 5:00 p.m. Pharmacy Services CT Pharmacy Assistance Program TTY: 711 Monday Friday: 8:00 a.m. to 5:00 p.m. Nurse Helpline hours a day/365 days a year TTY: 711 Fraud Reporting Hotline CHANGES TO YOUR INFORMATION If you are a HUSKY C member: Please follow the below instructions when reporting a change. If you are a HUSKY A or HUSKY D member: You may follow the below instructions, OR You may report changes online through Access Health CT (www.accesshealthct.com), OR You may call Access Health CT at To report address, phone number, income, or demographic changes, or a change in household members, please go to the Department of Social Services website. Follow these instructions: If you have already opened a MyAccount and have connected your Client ID to your account: Click on this link to go to your account Click on Report Change on the top of the page If you have already opened a MyAccount but it is not connected to your Client ID: Click on this link Look for the Associate Case instructions Connect your Client ID with your MyAccount Click on Report Change on the top of the page If you do not have a MyAccount: Click on this link Click on Create an Account in the MyAccount box Don t forget to link your Client ID to your MyAccount in the Associate Case area Revised 8/3/ Member Services

5 You may also report changes to your DSS Regional Office. You can find a list of all DSS Regional Offices below. Bridgeport 925 Housatonic Avenue Bridgeport, CT Danbury 342 Main Street Danbury, CT Hartford 3580 Main Street Hartford, CT Manchester 699 East Middle Turnpike Manchester, CT Middletown 117 Main Street Extension Middletown, CT New Britain 30 Christian Lane New Britain, CT New Haven 50 Humphrey Street New Haven, CT Norwich 401 West Thames Street Norwich, CT Stamford 1642 Bedford Street Stamford, CT Torrington 62 Commercial Boulevard Torrington, CT Waterbury 249 Thomaston Avenue Waterbury, CT Willimantic 676 Main Street Willimantic, CT State Department of Social Services (DSS) Regional Offices Bridgeport, Easton, Fairfield, Monroe, Norwalk, Stratford, Trumbull, Weston, Westport Bethel, Bridgewater, Brookfield, Danbury, New Fairfield, New Milford, Newtown, Redding, Ridgefield, Sherman Avon, Bloomfield, Canton, East Granby, Farmington, Granby, Newington, Rocky Hill, Simsbury, Suffield, West Hartford, Wethersfield, Windsor, Windsor Locks Andover, Bolton, East Hartford, East Windsor, Ellington, Enfield, Glastonbury, Hebron, Manchester, Marlborough, Somers, South Windsor, Stafford, Tolland, Vernon Chester, Clinton, Cromwell, Deep River, Durham, East Haddam, East Hampton, Essex, Guilford, Haddam, Killingworth, Lyme, Madison, Meriden, Middlefield, Middletown, Old Lyme, Old Saybrook, Portland, Westbrook Berlin, Bristol, Burlington, New Britain, Plainville, Plymouth, Southington Ansonia, Bethany, Branford, Derby, East Haven, Hamden, Milford, New Haven, North Branford, North Haven, Orange, Seymour, Shelton, Wallingford, West Haven, Woodbridge Bozrah, Colchester, East Lyme, Franklin, Griswold, Groton, Lebanon, Ledyard, Lisbon, Montville, Preston, Salem, Sprague, Stonington, Voluntown, Waterford Darien, Greenwich, New Canaan, Stamford, Wilton Barkhamsted, Bethlehem, Canaan, Colebrook, Cornwall, Goshen, Hartland, Harwinton, Kent, Litchfield, Morris, New Hartford, Norfolk, North Canaan, Roxbury, Salisbury, Sharon, Thomaston, Torrington, Warren, Washington, Winchester, Woodbury Beacon Falls, Cheshire, Middlebury, Naugatuck, Oxford, Prospect, Southbury, Waterbury, Watertown, Wolcott Ashford, Brooklyn, Canterbury, Chaplin, Columbia, Coventry, Eastford, Hampton, Killingly, Mansfield, Plainfield, Pomfret, Putnam, Scotland, Sterling, Thompson, Union, Willington, Windham, Woodstock If you are deaf or hard of hearing, please dial Revised 8/3/ Member Services

6 WELCOME TO THE HUSKY HEALTH PROGRAM! Thank you for joining the HUSKY Health program! This handbook will help you understand your HUSKY benefits and the services available to you. HUSKY Health is committed to your care. HUSKY Health will help you understand your Medicaid benefits and provide you with services to help keep you healthy. Our goal is to help you and your providers work together to make sure you get the best care possible. We look forward to hearing from you! Getting the Most out of Your Membership Please call Member Services with any questions. The phone number is We are open Monday through Friday from 8:00 a.m. to 6:00 p.m. Member Services can help you: Find a provider and make appointments Choose or change a Primary Care Provider (PCP) Learn about covered services and how to get them Set up an interpreter for medical appointments if English is not your first language Learn about special programs you can use Find resources in your community that can help you Member Services can give you information about the benefits and services available to you from the HUSKY Health program. We can tell you how the program works and answer any questions you may have. We have many people at our Call Center that speak English and Spanish. If you speak a different language, we will get a translator for you. We have many special programs that help members with special healthcare needs. Details about these programs are in this handbook. If you still have questions after you read this handbook, please call us. Our phone number is HOW THE HUSKY HEALTH PROGRAM WORKS FOR YOU Our Website You can go online to find out the latest news about the HUSKY Health program. Our website is Click For Members on the left side of the screen to find the WELCOME MEMBERS page. The website also has: A benefit overview Behavioral health information o Connecticut Behavioral Health Partnership (CT BHP): Revised 8/3/ Member Services

7 Dental health information o Connecticut Dental Health Partnership (CTDHP): Details about how to get your pharmacy services A Contact Us link at the top of the site that you can use to ask questions Other useful links! WELCOME MEMBERS Page The WELCOME MEMBERS page of the HUSKY Health website is just for you. It puts a lot of details right at your fingertips. On the left side of this page, you will find links to: A Provider Directory that lets you search for providers in the Connecticut Medical Assistance Program (CMAP). You can search in your area by provider name, city, specialty, and more; Information about providers that offer care as a Patient-Centered Medical Home (PCMH); Member materials, such as the Welcome Guide and other important information; Health education materials; Details on Intensive Care Management (ICM) services; Other services such as dental, pharmacy, and behavioral health; and Community resources that can give you support, including baby supplies, utility help, and more. On the WELCOME MEMBERS page, you can learn more about your right to privacy. You can report possible fraud. The page also has a MY HEALTH CARE Member Login. This will bring you to a secure portal that is just for you! MY HEALTH CARE Secure Member Portal When you log in to the MY HEALTH CARE secure member portal, you can see your member information. You can also: View your member details. This includes your name, address, date of birth, and ID number; See who your Primary Care Provider (PCP) is and find out how to get a new one; Find out what to do if your ID card is lost, stolen, or damaged; Look at a list of all the providers in the CMAP network (this list is also on the WELCOME MEMBERS page); Learn about other programs that you can use; and Find out how to contact us. This portal is secure. That means all of your details are safe each time you use it. Revised 8/3/ Member Services

8 Secure Provider Portal Providers also have a secure web portal. This lets them see the health services and medicines they have given you in the past. Your Primary Care Provider (PCP) can also see health information about you from your other healthcare providers. This includes hospitals, specialists, and pharmacies. It does not include information from your mental health providers, unless you agree to it. Being able to look at your health information from your other providers helps your PCP make better decisions about the type of healthcare you need. If you do not want your PCP to be able to look at health information about you from your other providers, you can opt out. This means that you let HUSKY Health know that you do not want your PCP to see your health information from other providers. To opt out, you must ask HUSKY Health in writing. You can download a form to opt out by going to and clicking For Members. You can also call Member Services if you need a form mailed to you. The phone number is If you are the head of a household, you may also opt out for children who are under 18. If there are two adults in the household, each must opt out on their own. You can opt out at any time. If you have opted out, you may change your mind. You can cancel your opt out request at any time. All you need to do is fill out a form. It is on our website. Just go to and click For Members. You can also call us at Member ID Card The HUSKY Health program sends a Member ID card to all new members. Don t share your card with anyone. When you get your new HUSKY Member ID card, look for your name. If your name is wrong, follow the steps on page 1 under CHANGES TO YOUR INFORMATION. You may also call your DSS Regional Office. If you are not sure which office to call, please see the information on page 2. You can also call Member Services. The phone number is Always keep your Member ID card with you. Show this card each time you go for medical services. Your provider s name will not be printed on the card. There is a place on the back of the card for your PCP to print his/her name. This is a sample Member ID card: Revised 8/3/ Member Services

9 DSS will also send you a gray CONNECT card. Please bring this card and your HUSKY Health ID card to all of the services covered by the HUSKY Health program. This includes medical, behavioral health, dental, and pharmacy services. This is a sample CONNECT card: For members who also have Medicare Part D pharmacy coverage: please only show your Medicare Part D card and your gray CONNECT card at the pharmacy. Nurse Helpline HUSKY Health gives members a way to contact a registered nurse 24 hours a day, 7 days a week through our Nurse Helpline. Skilled nurses are here if you are sick, hurt, or need healthcare advice. They can help you decide what to do. Our 24/7 Nurse Helpline will: Answer your healthcare questions quickly and correctly; Tell you where you can go to get the care you need; and Teach you about self-care and how to find out what services you can use. Please call for the Nurse Helpline. Translation and Interpretation Services If you need an interpreter for your medical appointments, an interpreter can call your provider s office when you are there and help you over the phone. Just call Member Services to help you. The phone number is In-person interpretation can be in most spoken languages or sign language. If you would like to have an interpreter with you at your provider s office, you need to call HUSKY Health and tell us you would like a face-to-face interpreter. For non-emergency appointments, we need 3 business days (business days do not include Saturday, Sunday, or holidays) notice to set up an interpreter for you. For example, if your appointment is on Thursday, please call us by Monday. If there is an emergency, an appointment with a translator can be made right away. Revised 8/3/ Member Services

10 If you call us and want to speak in a language other than English, our Member Services staff can call an interpreter line. This will let us talk to you in your language. We have staff members who speak Spanish. If you need to have our written materials translated, we can help. We are able to translate any written material into the language you speak. If you have trouble seeing, our written materials can be printed with larger words. We can also copy them into braille. We want to make sure you can talk with your providers and with us. If you need help, just call us. Our phone number is HOW TO ACCESS YOUR HEALTHCARE SERVICES HUSKY Health Providers You will get all HUSKY Health services from healthcare providers who are part of the Connecticut Medical Assistance Program (CMAP) network. You can use the HUSKY Health Provider Directory on our website to find providers who are part of the program. The website is Click For Members, then click Find a Provider on the left. You can then look at the CMAP (HUSKY) Provider Directory. You can also call Member Services for help with finding providers. If you are a patient of any providers who are not in the Provider Directory, you can call them to find out if they are part of CMAP (HUSKY). If they are not, you can ask them if they want to join. If your providers are not part of CMAP (HUSKY) but want to join, please call Member Services. Our phone number is We can call your providers and talk to them about joining. We can help them enroll so that they can treat HUSKY Health Program members. If your providers do not want to join the CMAP network, we can help you find new providers. We can even help make an appointment for you. The Provider Directory can also be found in the MY HEALTH CARE secure member web portal. Choosing Your Primary Care Provider It is important that you have a Primary Care Provider (PCP). Your PCP is the main source of your healthcare. You should have a good relationship with your PCP. A PCP will know your health history and can follow your healthcare needs as they change over time. You should see your PCP for check-ups. You should also see your PCP when you feel sick. It is very important to have a PCP if you have serious healthcare needs or many problems with your health. You can call Member Services to choose a PCP or change the one you currently have. Our phone number is We can help you Monday through Friday. Our hours are 8:00 a.m. to 6:00 p.m. We can also help you make an appointment to see your PCP. Revised 8/3/ Member Services

11 If you do not choose a PCP, we will assume that the provider you saw in the past is your PCP. You can see who your PCP is by visiting our secure website at Click For Members, and then MY HEALTH CARE Member Login. You can change your PCP at any time. Just give us a call. If you change your PCP, you do not need a new Member ID card. The HUSKY Health ID card you have right now will work for any PCP that you see. There are different types of medical providers who can be your PCP. They are: PCP Type Family Practitioner General Pediatrician General Practitioner/Internal Medicine Geriatric Practitioner Adult Health Nurse Practitioner Physician Assistant (PA) Osteopath - Doctor of Osteopathic Medicine (DO) Person-Centered Medical Home (PCMH) Specialty on the Provider Search Description webpage A medical doctor who cares for all Family Practitioner family members. A medical doctor who cares for children generally up to age 18 or 21. A medical doctor who offers preventive care and treats a wide range of health problems. A medical doctor who cares for older adults generally age 60 and up. A registered nurse who has extra training and treats the medical needs of adults. A healthcare professional trained to take care of your medical needs. He or she is supervised by a doctor. A medical doctor who offers care to children and adults with a focus on treating both the mind and body, the connection between muscles and bones and the causes of disease. A care team that works together and is led by a PCP. It makes sure you get care from all team members when you need it. General Pediatrician, Pediatric Adolescent Medicine, Pediatric Nurse Practitioner General Practitioner, Internal Medicine, Preventative Medicine Geriatric Practitioner, Geriatric Nurse Practitioner Adult Health Nurse Practitioner, Family Nurse Practitioner, Nurse Practitioner (OTHER), Primary Care Nurse Practitioner Physician Assistant, Primary Care Physician Assistant, Medical Physician Assistant Osteopath PCMH practices can be found by clicking the View a list of PCMH Practices link from the FIND A DOCTOR page. Revised 8/3/ Member Services

12 Specialists The HUSKY Health program does not require a note from your PCP to see a medical specialist. An example of a specialist could be an ear, nose, and throat provider. Other examples are a surgeon, allergist, or pulmonary (lung) provider. You should tell your PCP if you visit a specialist. This will help your PCP keep track of your care. There are also times when a specialist will only see a new patient after he or she is seen by a PCP. If you need a specialist, your PCP or HUSKY Member Services can help you. Call us at You can also use the HUSKY Health Provider Directory to find a specialist. Second Opinions You have the right to get a second opinion on any medical diagnosis. There are many reasons you might want to ask for a second opinion. Some reasons are: You think there could be better treatments; You are not getting better even though you have followed your provider s orders; The treatment is very serious, like surgery or chemotherapy; The treatment is long-term or life-long; The treatment has serious medical risks; and/or You do not completely trust your provider s advice. Getting a second opinion may give you more details about your diagnosis. It will help you feel that you are making the best decision possible when it comes to your treatment. You can get a second opinion at no cost. If you need help finding a provider for a second opinion, call us. Our phone number is HUSKY BENEFITS Below, you will find a summary of your HUSKY benefits. These services are available to you at no cost 1. They must be medically necessary in order to get them. Medically necessary means medical, dental, and behavioral health services needed to: Keep you as healthy as possible; Improve your health; Find or treat an illness; Help you get better after getting hurt; or 1 If you are dually-eligible, meaning you have both Medicare and Medicaid, you may have a co-payment at the pharmacy. Please see the Pharmacy section for more information. Revised 8/3/ Member Services

13 Help you function on your own. Medically necessary services must meet standards for quality medical care. They must: Be the right type, level, amount, or length for you; Be given in the right healthcare setting; Not be provided only to make things easier for you or for a provider; Cost no more than a different service that would get the same results; and Be based on your medical condition. Some of the covered goods/services, like radiology, might need prior authorization (pre-approval). This means that your provider must first get approval from the HUSKY Health program before you get the service. Some services, like preventive care, do not need prior authorization. If a service needs this approval, you do not have to contact the HUSKY Health program. Your provider will do that for you. HUSKY Health will only make a payment for services to a provider who is part of the Connecticut Medical Assistance Program (CMAP) network. If you need help finding a participating provider, please call our Member Service department. The phone number is We are open Monday through Friday from 8:00 a.m. to 6:00 p.m. The information below is a guide to understanding your benefits. It is a general list and does not name every service that is covered or all of the rules for each service. That information can be found in the Medicaid regulations and policies 2. If you have any questions about whether or not a service is covered, or if you would like more information about your benefits, please call our Member Services department. The phone number is We look forward to helping you any way that we can! EARLY AND PERIODIC SCREENING, DIAGNOSTIC, AND TREATMENT (EPSDT) SERVICES Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services is a program to make sure that children, up to age 21, get the care they need to grow up healthy. EPSDT services include well-care visits for children. A well-care visit is when your child sees the PCP for a routine check-up. The reason for the visit is to see how your child is growing and developing. The EPSDT/well-care visit includes a complete exam. This will include checking your child s height and weight. The provider will do a vision and hearing test. He or she will test your child s blood to check lead levels. Depending on the age and health history of your child, the PCP may also give your child a shot. The provider can give you advice about your child s nutritional needs and activity levels. This is also a good time for you to ask questions about your child s health. 2 For more information about Medicaid regulations and policies, please visit Revised 8/3/ Member Services

14 The EPSDT/well-care schedule is based on your child s age. AGE NEWBORN TO 9 MONTHS 12 MONTHS TO 2 ½ YEARS OLD NUMBER OF WELL-CARE VISITS* 6 visits, which take place at: 3-5 days 1 month 2 months 4 months 6 months 9 months 5 visits, which take place at: 12 months 15 months 18 months 24 months 30 months 3 TO 21 YEARS OLD One visit per year *At least. More visits may be needed. We can help you make appointments for EPSDT services. We also help providers reach out to their patients who are HUSKY Health members that need EPSDT services. This is so that providers can follow up with these members. We can help you find a provider and set up these EPSDT services: Medical check-ups, which include reminders to tell you about appointments; Shots, when needed; Blood and lab tests, when needed; Regular vision and hearing check-ups; Health education; and Details about services your child may need. We can also help you set up transportation for your EPSDT appointments. Please see the Transportation section on page 23 to find out how. If you need a translator for your EPSDT appointment, HUSKY Health can set one up. Please see the section on Translation and Interpretation Services on page 6 for more information. Under EPSDT, children may get Medicaid services that are not available to HUSKY Health adults. Also, limits on the number of visits or services that may apply to adults do not apply to children. There are EPSDT care management services available. These services help members up to age 21. Please see the INTENSIVE CARE MANAGEMENT (ICM) section on page 28 for more details. Revised 8/3/ Member Services

15 COVERED SERVICES Ambulatory Surgery An ambulatory surgery center is a healthcare facility that provides surgery and certain diagnostic services, like a colonoscopy. It is an outpatient setting, so patients do not spend the night. An ambulatory surgery center is not a hospital. These services are not serious enough to be done in a hospital, but are too serious to be done in the provider s office. Ambulatory surgery centers do not provide emergency services. They may focus on one or more of these specialties: Dermatology Ear, nose, and throat Gastroenterology General surgery Gynecology Ophthalmology Orthopedics Urology Ambulance Ambulance services are 100% covered. Behavioral Health Services The Connecticut Behavioral Health Partnership (CT BHP) can help you find the mental health and/or substance abuse services you need. How to reach the CT BHP: Call their Customer Service department. It is open Monday through Friday from 9:00 a.m. to 7:00 p.m. The phone number is If you are deaf or hard of hearing, call 711. They can help you with free language translation if you need it. Visit their website. The web address is Behavioral Health services include: Inpatient hospital care for mental health problems 23-hour observation Inpatient detoxification Partial hospitalization Outpatient services provided by hospitals, freestanding clinics, and behavioral health providers in independent practice Medications for behavioral health conditions Counseling to help you stop smoking Extended day treatment Revised 8/3/ Member Services

16 Crisis stabilization beds for children and adolescents Emergency Mobile Psychiatric Services for kids Psychiatric Residential Treatment Facility Residential treatment center for children Autism and assessment treatment services Adult and child group homes Home-based services Case management Intensive outpatient services Electro Convulsive Therapy Methadone maintenance Suboxone treatment Ambulatory detoxification Early and Periodic Screening, Diagnostic, and Treatment Services Psychological testing Home health agency services Behavioral Health providers are doctors, nurses, licensed psychologists, clinical social workers, marriage and family therapists, professional counselors, or alcohol and drug counselors. They can help you get treatment. You do not need a referral to get mental health or substance abuse services. If your behavioral health provider is not part of the CMAP network, you can ask him or her to call the CT BHP. The phone number is The CT BHP will help your provider join the network. Ways you can find a behavioral health provider: Call the CT BHP. The phone number is It is open Monday through Friday from 9:00 a.m. to 7:00 p.m. Visit their website at Click For Members, and then Find a Provider. Chiropractor A chiropractor treats problems with your back. Members UNDER AGE 21 can get services from an independently enrolled provider ONLY when it is medically necessary. It must be a part of EPSDT Special Services. Once prior authorization is received, the services are completely covered. Chronic Disease Hospital A Chronic Disease Hospital is for people who require long-term care due to a chronic illness or a health condition (such as Traumatic Brain Injury) that needs an intensive recovery program. HUSKY Health must approve a member s stay at a Chronic Disease Hospital. A chronic illness must be one or more of the following in order for HUSKY Health to consider a member s stay at a Chronic Disease Hospital: Revised 8/3/ Member Services

17 The illness is permanent; It leads to a lasting disability; It is caused by something that cannot be changed with treatment; A member needs special training to function better; and/or A member needs long-term care because of the illness. Some members may not have a chronic illness, but a health condition that needs an intensive recovery program. These members may also qualify for this benefit. HUSKY Health will decide if there is a possibility that the member would function better or be free from pain. When members meet the criteria and it is decided that care at a Chronic Disease Hospital is medically necessary, HUSKY Health will cover the hospital stay and services related to it. Clinic Services A free-standing clinic is a licensed facility not associated with a hospital. Services that you can get from a clinic include: Dialysis Family Planning Rehabilitation See Physician Services section on page 23 for routine services provided in a medical clinic. Dental Services Your dental care is covered under the HUSKY Health program by the Connecticut Dental Health Partnership (CTDHP). The health of your mouth is related to the health of your entire body. This is why it is important to visit your dentist on a regular basis. The CTDHP provides complete dental coverage to help keep your teeth healthy and care for any teeth and mouth problems. Dental services covered under your plan include: Prevention services such as cleaning, fluoride, sealants, and X-rays Restorative care: fillings and crowns Endodontic care: root canal treatment Oral surgery and dentures Orthodontics (braces) are provided to children under the age of twenty-one (21) when a dentist or orthodontist determines they are necessary based on a complete evaluation Some of these services may need prior authorization by your dental provider. If you need help finding a dentist or making an appointment, please call the CTDHP. The phone number is They are open Monday through Friday from 8:00 a.m. to 5:00 p.m. The CTDHP will help set up your transportation and translation services, if needed. The CTDHP will also provide care Revised 8/3/ Member Services

18 coordination if a member has serious dental problems. If you are hard of hearing, you can call TDD/TTY for help. The phone number is 711. You can also visit the CTDHP website at Dialysis Dialysis services are a covered benefit. These services may be provided in a home, clinic, hospital, or institutional setting. Durable Medical Equipment Durable Medical Equipment (DME) is equipment that: Can be used over and over again; Is ordinarily used for medical purposes; Is generally not useful to a person who isn t sick, hurt, or disabled; and Is non-disposable. Some examples of covered DME are: Wheelchairs and accessories Walking aides, such as walkers, canes, and crutches Bathroom equipment, such as commodes and safety equipment Inhalation therapy equipment, such as nebulizers Hospital beds and accessories Other devices, such as CPAP machines, apnea monitors, and ventilators Insulin pumps and diabetic supplies Breast pumps You will need a prescription from your provider for DME. Prior authorization is also needed for many DME items. If prior authorization is needed, your DME vendor will call the HUSKY Health program. The Department of Social Services (DSS) has a list of DME that it pays for. Other items may be approved for coverage based on each member s case. Your medical equipment provider can call Member Services at to find out which supplies are covered. Emergency Care Emergency Care is medical care that is needed right away. Go to a hospital Emergency Room or call 911 if you have an emergency. Examples are: Bleeding that can t be stopped Chest pains Serious burns Seizures or convulsions Revised 8/3/ Member Services

19 Other health problems that could cause death or serious injury If you go to the Emergency Room, bring your HUSKY Health ID card. Also bring your CONNECT CARD. Ask the ER staff to call your PCP or specialist when you arrive. You do not need an authorization for emergency care. You should always follow up with your PCP after you go to the Emergency Room. It is recommended that you call your PCP right after your Emergency Room visit and schedule an office visit. This will allow them to check on your recovery and see if there is any change in your condition or medicines. Remember to bring your medication list and the instructions you were given in the Emergency Room. If you need help making an appointment, please call Member Services at You do not need an approval to get emergency care. If you get out-of-state emergency care in an Emergency Room, approval is not needed. However, the facility must enroll in CMAP in order to be paid for these services. If the provider does not enroll, you may receive a bill for these emergency services. If out-of-state emergency care is needed, you should call your PCP within 24 hours of the Emergency Room visit. Out-of-state emergency care at a provider s office is not covered. Also, out-of- country care is not covered, except for Puerto Rico and other USA territories. However, the facility must enroll in CMAP in order to be paid for these services. If the provider does not enroll, you may receive a bill for these emergency services. Eye/Vision Care Vision care is a covered service that can be done by ophthalmologists, optometrists, and opticians. Please keep in mind: Eye exams are covered; and For members who are age 21 or older, one (1) pair of eyeglasses will be covered every two (2) years. If there has been a serious change in vision and the member needs a new prescription for eyeglasses, they will be covered. * * No exception will be made for eyeglasses that are lost, stolen, or broken Family Planning Family planning services include those that diagnose, treat, and counsel individuals of child-bearing age. Covered family planning services include: Reproductive health exams Patient counseling and education related to family planning Lab tests to detect the presence of conditions affecting reproductive health Screening, testing, treatment, and pre- and post-test counseling for sexually transmitted diseases and HIV Revised 8/3/ Member Services

20 Contraceptives: a contraceptive can be a pill, patch, medication, condoms, or other device used to prevent pregnancy Sterilization is covered for members 21 years of age or older. Sterilization includes tubal ligations for females and vasectomies for males Abortion Hysterectomies are only covered for medical reasons. They are not covered for family planning. Services for infertility, including reversal sterilization, in vitro fertilization, artificial insemination, and fertility drugs, are not covered. Gender Reassignment Surgery With gender reassignment, a patient undergoes a series of procedures to change their physical appearance, and often the function of their existing sexual organs, to look like that of the opposite sex. Gender reassignment surgery is not a single procedure, but part of a complex process involving multiple medical, psychiatric, and surgical specialists. Members must have prior approval for gender reassignment surgery. Hearing Aids & Exams (Audiologists) Both hearing aids and hearing exams are covered. A prescription from a provider is usually needed for hearing aids. Home Health Care Services Home health agencies will deliver in-home services for those who need them. These services include: Skilled nursing visits Home health aide assistance, only with the following daily activities: dressing, bathing, oral hygiene, eating, transferring (help with walking or changing a position, like going from sitting to laying down), and toileting Maternity visits for women who have high-risk pregnancies Short-term rehabilitation including physical therapy, speech therapy, and occupational therapy Prior authorization is needed for some home health services. Cleaning or homemaker services are not covered benefits. Hospice Hospice provides medical, emotional, and spiritual support during the final stages of an illness that cannot be cured. The goal of hospice is to provide comfort and quality of life. Hospice services are available to members who are terminally ill and a provider has determined that they have six months or less to live. Hospice services offer treatment aimed at relieving the symptoms of the illness and keeping terminal members as comfortable as possible. Hospice can be provided in an inpatient or outpatient setting. Members have the right to choose this option by filling out a Hospice Election form available through providers. Hospice services include: Revised 8/3/ Member Services

Connecticut Adult Education Programs

Connecticut Adult Education Programs Connecticut Adult Education Programs Please note that the programs highlighted in BLUE offer the 2014 GED Test on computer. TOWN ANDOVER ANSONIA ASHFORD AVON BARKHAMSTED BEACON FALLS BERLIN BETHANY BETHEL

More information

Connecticut Single Family Home Sales: 2008:Q1

Connecticut Single Family Home Sales: 2008:Q1 Connecticut Single Family Home Sales: 2008:Q1 Overview There were 4,892 sales of single family homes in Connecticut during the 1 ST quarter of 2008, a decrease of 1,815 from the previous quarter, and of

More information

Eviction and Foreclosure Prevention Program

Eviction and Foreclosure Prevention Program Eviction and Foreclosure Prevention Program Description: The Eviction and Foreclosure Prevention Program is a statewide program designed to prevent evictions and foreclosures through mediation and a Rent

More information

Bureau of Rehabilitation Services /CT Tech Act Project Description of Assistive Technology, (AT), Services

Bureau of Rehabilitation Services /CT Tech Act Project Description of Assistive Technology, (AT), Services APPENDIX A - Assistive Technology Services Application Bureau of Rehabilitation Services /CT Tech Act Project Description of Assistive Technology, (AT), Services 1. AT Evaluation: A full AT evaluation

More information

UTILITY BY TOWN LIST. Andover TOWN NUMBER: 1 DISTRICT NUMBER: 1 Cable TV. Communication (The Southern New England Telephone Company)

UTILITY BY TOWN LIST. Andover TOWN NUMBER: 1 DISTRICT NUMBER: 1 Cable TV. Communication (The Southern New England Telephone Company) Andover TOWN NUMBER: 1 DISTRICT NUMBER: 1 Comcast of Eastern Connecticut, Inc dba: Comcast Vernon Spectra Energy Operating Company, LLC (formerly: Algonquin Transmission Company) Page 1 of 169 Ansonia

More information

Department of Mental Health and Addiction Services

Department of Mental Health and Addiction Services Description: Department of Mental Health and Addiction Services The Department of Mental Health and Addiction Services (DMHAS) is the state healthcare service agency responsible for health promotion and

More information

CONNECTICUT MEDICAID. Summary of Services. Medical Care Administration Department of Social Services

CONNECTICUT MEDICAID. Summary of Services. Medical Care Administration Department of Social Services CONNECTICUT MEDICAID Summary of Services Medical Care Administration Department of Social Services TABLE OF CONTENTS 1. Overview 3 2. Ambulatory Surgery 4 3. Dental Services 4 4. Dialysis Services 5 5.

More information

TOWN OF NEWTOWN GENERAL FUND BONDED DEBT ANALYSIS PAST TWENTY YEARS, PRESENT AND INTO THE FUTURE

TOWN OF NEWTOWN GENERAL FUND BONDED DEBT ANALYSIS PAST TWENTY YEARS, PRESENT AND INTO THE FUTURE TOWN OF NEWTOWN GENERAL FUND BONDED DEBT ANALYSIS PAST TWENTY YEARS, PRESENT AND INTO THE FUTURE RTAIT 08/10/2015 1 2 Capital Financing A Capital Financing Strategy is essential for any local government

More information

Probationer Handbook. Key to Your Success. Case # Name. Probation Office. Address/Number

Probationer Handbook. Key to Your Success. Case # Name. Probation Office. Address/Number Case # Name Probation Office Address/Number Probationer Handbook Key to Your Success State of Connecticut Judicial Branch Court Support Services Division Why Should I Read This Book? Probation is a time

More information

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....

More information

School Breakfast REPORT CARD. 2014 Connecticut

School Breakfast REPORT CARD. 2014 Connecticut 2014 Connecticut School Breakfast REPORT CARD Long gone are the days when families have time in the morning to sit down at the kitchen table for breakfast. A recent social impact analysis conducted by

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). Eligibility for this program will be determined

More information

If you have a question about whether MedStar Family Choice covers certain health care, call MedStar Family Choice Member Services at 888-404-3549.

If you have a question about whether MedStar Family Choice covers certain health care, call MedStar Family Choice Member Services at 888-404-3549. Your Health Benefits Health services covered by MedStar Family Choice The list below shows the healthcare services and benefits for all MedStar Family Choice members. For some benefits, you have to be

More information

Summary of Services and Cost Shares

Summary of Services and Cost Shares Summary of Services and Cost Shares This summary does not describe benefits. For the description of a benefit, including any limitations or exclusions, please refer to the identical heading in the Benefits

More information

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

HNE Premier 1 (HMO) and HNE Premier 2 (HMO) 2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

More information

MedStar Family Choice Benefits Summary District of Columbia- Healthy Families WHAT YOU GET WHO CAN GET THIS BENEFIT BENEFIT

MedStar Family Choice Benefits Summary District of Columbia- Healthy Families WHAT YOU GET WHO CAN GET THIS BENEFIT BENEFIT Primary Care Services Specialist Services Laboratory & X-ray Services Hospital Services Pharmacy Services (prescription drugs) Emergency Services Preventive, acute, and chronic health care Services generally

More information

AGING, DISABILITY AND SUBSTANCE ABUSE RECOVERY RESOURCES

AGING, DISABILITY AND SUBSTANCE ABUSE RECOVERY RESOURCES AGING, DISABILITY AND SUBSTANCE ABUSE RECOVERY RESOURCES Courtesy of The University of Connecticut Center on Disabilities, The Department of Mental Health and Addiction Services, and The Department of

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1 January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list

More information

Summary of Benefits Community Advantage (HMO)

Summary of Benefits Community Advantage (HMO) Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

More information

Covered Service Description

Covered Service Description Advanced registered nurse practitioner (ARNP) Ambulatory surgical center (ASC) These are given by an ARNP who s licensed to practice in the State of Florida The ARNP and a doctor must make decisions about

More information

2015 Medicare Advantage Summary of Benefits

2015 Medicare Advantage Summary of Benefits 2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015

More information

State unemployment rate declines to 5.7% in July; nonfarm jobs up 1,700

State unemployment rate declines to 5.7% in July; nonfarm jobs up 1,700 Lincoln.dyer@ct.gov appears Office of Research Scott D. Jackson, Commissioner FOR IMMEDIATE RELEASE July 2016 Data CT Unemployment Rate = 5.7% US Unemployment Rate = 4.9% State unemployment rate declines

More information

[2015] SUMMARY OF BENEFITS H1189_2015SB

[2015] SUMMARY OF BENEFITS H1189_2015SB [2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare

More information

California Small Group MC Aetna Life Insurance Company

California Small Group MC Aetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $3,000 Individual $6,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate separately

More information

PUBLIC SAFETY DATA NETWORK

PUBLIC SAFETY DATA NETWORK PUBLIC SAFETY DATA NETWORK Office of Statewide Emergency Telecommunications Bill Youell Steve Verbil November 1, 20 PUBLIC SAFETY DATA NETWORK PSDN: high speed, optical based data transport network connecting

More information

Benefits and Services

Benefits and Services Benefits and HealthChoice benefits The table below shows the health care services and benefits that all HealthChoice enrollees can get when they need them. We offer other services not listed here (see

More information

January 1, 2015 December 31, 2015

January 1, 2015 December 31, 2015 BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)

More information

Schedule of Benefits HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS MEMBER COST SHARING

Schedule of Benefits HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS MEMBER COST SHARING Schedule of s HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS ID: MD0000003378_ X Please Note: In this plan, Members have access to network benefits only from the providers in the Harvard Pilgrim-Lahey

More information

Independent Health s Medicare Passport Advantage (PPO)

Independent Health s Medicare Passport Advantage (PPO) Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of

More information

PPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20

PPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20 PPO Schedule of Payments (Maryland Large Group) Qualified High Health Plan National QA2000-20 Benefit Year Individual Family (Amounts for Participating and s services are separated in calculating when

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015

More information

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C Service Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ Division of Developmental Disabilities (DDD) NJ FamilyCare B NJ FamilyCare C NJ FamilyCare D Abortions and related services (covered

More information

Primary and Acute Medical Services

Primary and Acute Medical Services Primary and Acute Medical Ambulance Medically necessary emergent ground and air ambulance transport. Air (fixed wing and air) ambulance Ground ambulance Chemotherapy Outpatient hospital for radiation therapy

More information

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO) FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY

More information

Covered Services. Health and Development History. Nutritional assessment. visit per year from 2 to 20 years of age

Covered Services. Health and Development History. Nutritional assessment. visit per year from 2 to 20 years of age You may receive covered services that are performed, prescribed or directed by a participating provider. As an Enrollee, you must receive your healthcare services from a participating PCP or medical provider.

More information

Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711)

Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711) Summary of s and January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website at www.martinspoint.org/medicare. 1-888-408-8285

More information

Summary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO)

Summary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO) Summary of Benefits January 1, 2016 December 31, 2016 FIRSTCAROLINACARE INSURANCE COMPANY FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties This booklet

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

Member Handbook. January 5, 2011. APPROVED BY DMAP on 01/05/2011

Member Handbook. January 5, 2011. APPROVED BY DMAP on 01/05/2011 Handbook For members living in the following counties in Oregon: Grant, Harney, Hood River, Lake (excluding zip codes 97620, 97630, 97635, 97636, and 97637), Sherman, Wasco, and Wheeler January 5, 2011

More information

Section XV Services for Persons with Disabilities

Section XV Services for Persons with Disabilities Section XV Services for Persons with Disabilities Description: Acquired Brain Injury (ABI) Waiver The Social Work Services Division of the Department of Social Services implements the Acquired Brain Injury

More information

PPO Hospital Care I DRAFT 18973

PPO Hospital Care I DRAFT 18973 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ibx.com or by calling 1-800-ASK-BLUE. Important Questions

More information

Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered.

Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered. Covered Benefits Services Abortions Allergy Testing Audiology Birth Control Services Blood & Blood Plasma Bone Mass Measurement (bone density) Case Management Chemotherapy Chiropractor Services (manipulation/subluxation)

More information

GIC Medicare Enrolled Retirees

GIC Medicare Enrolled Retirees GIC Medicare Enrolled Retirees HMO Summary of Benefits Chart This chart provides a summary of key services offered by your HNE plan. Consult your Member Handbook for a full description of your plan s benefits

More information

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare

Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will

More information

SECTION A. Summary of Benefits LW-V, 10/09

SECTION A. Summary of Benefits LW-V, 10/09 SECTION A. Summary of Benefits LW-V, 10/09 This Summary is part of your Benefit Handbook. It states the Cost Sharing amounts that you must pay for Covered Benefits and some important limitations on your

More information

United States Fire Insurance Company: International Technological University Coverage Period: beginning on or after 9/7/2014

United States Fire Insurance Company: International Technological University Coverage Period: beginning on or after 9/7/2014 or after 9/7/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: PPO This is only a summary. If you want more detail about your coverage and

More information

Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare

Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 24 (HMO-POS). Next year, there will

More information

Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary

Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary 5 Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Plans Medicare members, by plan. Topics: Health

More information

Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary

Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary 5 Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Medicare members, by plan. Topics: Health Partners

More information

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA)

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) 10/2012 Coverage for Newborn and Foster Children Coverage Outside the Provider Network Adult Routine Physical Exams Well-Baby and Well-Child

More information

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2015 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?... 3 How Do I Reach Member Services?... 3 Is There A Website?....

More information

PRIMARY CARE CLINICIAN PLAN

PRIMARY CARE CLINICIAN PLAN PRIMARY CARE CLINICIAN PLAN MEMBER HANDBOOK Helping you with your health-plan benefits. 1-800-841-2900 TTY: 1-800-497-4648 www.mass.gov/masshealth These extra pages are the Covered Services List for your

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1 January 1, 2016 December 31, 2016 Summary of Benefits H3312-060 H3312.060.1 Y0001_2016_H3312_060 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

California Small Group MC Aetna Life Insurance Company

California Small Group MC Aetna Life Insurance Company PLAN FEATURES Deductible (per calendar year) $1,000 per member $1,000 per member Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate

More information

NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS

NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS WASHINGTON NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS General Features Calendar Year Deductible Lifetime Benefit Maximum (Does not apply to Chemical Dependency) ($5,000.00

More information

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare ABP BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services

Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services Alternative Benefit Plan (ABP) ABP Cost-Sharing & Comparison to Standard Medicaid Services Most adults who qualify for the Medicaid category known as the Other Adult Group receive services under the New

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8713_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with

More information

California PCP Selected* Not Applicable

California PCP Selected* Not Applicable PLAN FEATURES Deductible (per calendar ) Member Coinsurance * Not Applicable ** Not Applicable Copay Maximum (per calendar ) $3,000 per Individual $6,000 per Family All member copays accumulate toward

More information

SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix)

SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) SISC Custom SaveNet Zero Admit 10 Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Highlights: A description of the prescription drug coverage is provided separately

More information

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we

More information

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services)

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services) HMO-OA-CNT-30-45-500-500D-13 HMO Open Access Contract Year Plan Benefit Summary This is a brief summary of benefits. Refer to your Membership Agreement for complete details on benefits, conditions, limitations

More information

Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma

Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma Summary of Benefits 2016 HMO King, Pierce, Snohomish, Spokane and Thurston Counties premera.com/ma Plus Section 1 Introduction to the and Plus This booklet gives you a summary of what we cover and what

More information

MassHealth Enrollment Guide 1-800-841-2900 TTY 1-800-497-4648. Helping you with your health plan choices.

MassHealth Enrollment Guide 1-800-841-2900 TTY 1-800-497-4648. Helping you with your health plan choices. MassHealth Enrollment Guide 1-800-841-2900 TTY 1-800-497-4648 Helping you with your health plan choices. WHAT S INSIDE Section 1: What is MassHealth?... 2 Welcome! You Must Enroll in a Health Plan Why

More information

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10

PLAN DESIGN AND BENEFITS - New York Open Access EPO 1-10/10 PLAN FEATURES Deductible (per calendar year) $1,000 Individual $3,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

PREFERRED CARE. All covered expenses, including prescription drugs, accumulate toward both the preferred and non-preferred Payment Limit.

PREFERRED CARE. All covered expenses, including prescription drugs, accumulate toward both the preferred and non-preferred Payment Limit. PLAN FEATURES Deductible (per plan year) $300 Individual $300 Individual None Family None Family All covered expenses, excluding prescription drugs, accumulate toward both the preferred and non-preferred

More information

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare A BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595

Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015 HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 For Medicare-eligible beneficiaries residing in Arenac, Bay,

More information

Preauthorization Requirements * (as of January 1, 2016)

Preauthorization Requirements * (as of January 1, 2016) OFFICE VISITS Primary Care Office Visits Primary Care Home Visits Specialist Office Visits No Specialist Home Visits PREVENTIVE CARE Well Child Visits and Immunizations Adult Annual Physical Examinations

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8712_2014F File & Use Accepted 09032014 ( a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with a Medicare contract)

More information

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Select Plan (HMO) H3623-018 58.06.360.1-OH3 B

January 1, 2015 December 31, 2015. Summary of Benefits. Aetna Medicare Select Plan (HMO) H3623-018 58.06.360.1-OH3 B January, 205 December 3, 205 Summary of Benefits H3623-08 58.06.360.-OH3 B Y000_205_H3623_08_OH Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what

More information

Blue Cross Premier Bronze Extra

Blue Cross Premier Bronze Extra An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within Blue Cross Blue Shield of Michigan s unsurpassed statewide PPO network

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Prime Plan (HMO) H3931-087 H3931.087.1

January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Prime Plan (HMO) H3931-087 H3931.087.1 January 1, 2016 December 31, 2016 Summary of Benefits H3931-087 H3931.087.1 Y0001_2016_H3931_087 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

Medicare Benefit Review

Medicare Benefit Review Medicare Benefit Review What is Medicare? Medicare is Health Insurance For people 65 or older For people under 65 with certain disabilities For people at any age with End-Stage Renal Disease (permanent

More information

$6,350 Individual $12,700 Individual

$6,350 Individual $12,700 Individual PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible $5,000 Individual $10,000 Individual $10,000 Family $20,000 Family All covered expenses accumulate separately toward the preferred or non-preferred Deductible.

More information

APPENDIX C Description of CHIP Benefits

APPENDIX C Description of CHIP Benefits Inpatient General Acute and Inpatient Rehabilitation Hospital Unlimited. Includes: Hospital-provided physician services Semi-private room and board (or private if medically necessary as certified by attending)

More information

CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO)

CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO) Introduction to the Summary of Benefits Report for CDPHP CLASSIC (PPO) CDPHP CORE RX (PPO) CDPHP CLASSIC RX (PPO) CDPHP PRIME RX (PPO) January 1, 2015 December 31, 2015 CAPITAL, CENTRAL, SOUTHERN TIER,

More information

SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted

SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health

More information

General Cost Sharing Features In-Network Out-of-Network

General Cost Sharing Features In-Network Out-of-Network SECTION A. Summary of Benefits 9-RCF, 10/09 This Summary is part of your Benefit Handbook. It states the Cost Sharing amounts that you must pay for Covered Benefits and some important limitations on your

More information

Harvard Pilgrim Health Care of New England, Inc. THE HARVARD PILGRIM BEST BUY TIERED COPAYMENT HMO - LP NEW HAMPSHIRE

Harvard Pilgrim Health Care of New England, Inc. THE HARVARD PILGRIM BEST BUY TIERED COPAYMENT HMO - LP NEW HAMPSHIRE ID: MD0000003228_B3 X Schedule of s Harvard Pilgrim Health Care of New England, Inc. THE HARVARD PILGRIM BEST BUY TIERED COPAYMENT HMO - LP NEW HAMPSHIRE Coverage under this Plan is under the jurisdiction

More information

PLAN DESIGN & BENEFITS - CONCENTRIC MODEL

PLAN DESIGN & BENEFITS - CONCENTRIC MODEL PLAN FEATURES Deductible (per calendar year) Rice University None Family Member Coinsurance Applies to all expenses unless otherwise stated. Payment Limit (per calendar year) $1,500 Individual $3,000 Family

More information

LOCKHEED MARTIN AERONAUTICS COMPANY PALMDALE 2011 IAM NEGOTIATIONS UNDER AGE 65 LM HEALTHWORKS SUMMARY

LOCKHEED MARTIN AERONAUTICS COMPANY PALMDALE 2011 IAM NEGOTIATIONS UNDER AGE 65 LM HEALTHWORKS SUMMARY Annual Deductibles, Out-of-Pocket Maximums, Lifetime Maximum Benefits Calendar Year Deductible Calendar Year Out-of- Pocket Maximum Lifetime Maximum Per Individual Physician Office Visits Primary Care

More information

January 1, 2016 December 31, 2016. Summary of Benefits. Coventry Medicare Advantage Total Care (HMO) H2672-009 H2672.009.1

January 1, 2016 December 31, 2016. Summary of Benefits. Coventry Medicare Advantage Total Care (HMO) H2672-009 H2672.009.1 January 1, 2016 December 31, 2016 Summary of Benefits H2672-009 H2672.009.1 Y0001_2016_H2672_009 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of

More information

National PPO 1000. PPO Schedule of Payments (Maryland Small Group)

National PPO 1000. PPO Schedule of Payments (Maryland Small Group) PPO Schedule of Payments (Maryland Small Group) National PPO 1000 The benefits outlined in this Schedule are in addition to the benefits offered under Coventry Health & Life Insurance Company Small Employer

More information

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10*

New York Small Group Indemnity Aetna Life Insurance Company Plan Effective Date: 10/01/2010. PLAN DESIGN AND BENEFITS - NY Indemnity 1-10/10* PLAN FEATURES Deductible (per calendar year) $2,500 Individual $7,500 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services,

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits January 1, 2015 December 31, 2015 Houston/Beaumont Area Y0067_PRE_H4506_SETX_SB41_0814 CMS Accepted 09/13/2014 HMO-SETX-SB K41 2015 Section I Introduction to Summary of Benefits

More information

Optional PREFERRED CARE. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived PLAN FEATURES Deductible (per plan year) $2,000 Employee $2,000 Employee $3,000 Employee + Spouse $3,000 Employee + Spouse $3,000 Employee + Child(ren) $3,000 Employee + Child(ren) $4,000 Family $4,000

More information

L.A. Care s Medicare Advantage Special Needs Plan

L.A. Care s Medicare Advantage Special Needs Plan L.A. Care s Medicare Advantage Special Needs Plan Summary of Benefits 2008 for people with Medicare and Medi-Cal Thank you for your interest in L.A. Care Health Plan. Our plan is offered by L.A. CARE

More information

Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc.

Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc. Piedmont WellStar Medicare Choice (HMO) offered by Piedmont WellStar HealthPlans, Inc. Annual Notice of Changes for 2015 You are currently enrolled as a member of Piedmont WellStar Medicare Choice HMO.

More information

Informational Series. Community TM. Glossary of Health Insurance & Medical Terminology. (855) 624-6463 HealthOptions.

Informational Series. Community TM. Glossary of Health Insurance & Medical Terminology. (855) 624-6463 HealthOptions. Informational Series Glossary of Health Insurance & Medical Terminology How to use this glossary This glossary has many commonly used terms, but isn t a full list. These glossary terms and definitions

More information

SUMMARY OF BENEFITS 2016 EmblemHealth PPO I and EmblemHealth Advantage (PPO) Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester

SUMMARY OF BENEFITS 2016 EmblemHealth PPO I and EmblemHealth Advantage (PPO) Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester SUMMARY OF BENEFITS 2016 and Bronx, Kings, New York, Nassau, Queens Richmond, Suffolk and Westchester January 1, 2016 December 31, 2016 H5528_125910 Accepted 9/13/2015 SECTION I - INTRODUCTION TO SUMMARY

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) (H4270) January 1, 2015 - December 31, 2015 Western Wisconsin (26 Counties) H4270_082914_1 CMS Accepted (09032014) SECTION I INTRODUCTION

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not

More information

Effective January 1, 2014 through December 31, 2014

Effective January 1, 2014 through December 31, 2014 Summary of Benefits Effective January 1, 2014 through December 31, 2014 The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.

More information