Member FAQs. Member Questions. General Questions about Inovalon. Personal Health Visits

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1 Member FAQs Member Questions Independence Blue Cross has selected Inovalon, Inc. and its health care quality program to make sure that members get their diagnoses confirmed, amended, and updated every year, as well as have potential preventive care gaps addressed. General Questions about Inovalon 1. What is Inovalon? Inovalon is an independent company that provides health care quality and care management services to more than 200 health care organizations and their members on a nationwide basis. 2. What will Inovalon do with my health information? The information collected by Inovalon at the time of the exam will be provided to your doctor and to Independence Blue Cross. 3. Will the assessment results affect my health benefits? No, the assessment results do not affect your health benefit coverage or policy. 4. Am I eligible for a Personal Health Visit? All Keystone 65 HMO and Personal Choice PPO members are eligible to receive one Personal Healt Visit per calendar year. Personal Health Visits 1. What is the background of the medical professional who will see me? The medical professional will be a nurse practitioner who works in your area. He or she will talk to you about your health and perform a physical examination. The exam results will then be provided to your primary care physician. 2. What is the process for the assessment? What should I expect? A nurse practitioner will come to your home or you can visit a conveniently located center. The nurse practitioner will want to talk to you about your medical history, evaluate your current physical condition, and perform a physical exam. The process should take about an hour. The results will be shared with your doctor and we encourage you to contact your doctor to talk about your care and medications. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association /15

2 3. What does the physical exam involve? The assessment is a review of your overall health and includes measuring vital signs such as pulse and blood pressure. The medical professional will also examine your head and neck, heart, lungs, abdomen, skin, extremities, and nervous system. The medical professional will discuss symptoms of any present medical conditions and review your medical history with you. He or she will not write any prescriptions for you. Your doctor will still be the one taking care of you. 4. Is this HIPAA compliant? Yes. According to HIPAA Privacy Rules (CFR 160, 164), amended August 14, 2002, health care providers can disclose Protected Health Information (PHI) to health plans for the purpose of quality assurance, quality improvement, accreditation activities, and approved research studies. As defined by HIPAA, the role of Inovalon is that of a Business Associate of Independence Blue Cross and Inovalon is ethically and legally bound to protect, preserve, and maintain the confidentiality of any PHI it collects during an assessment. Inovalon will treat your PHI with the highest level of protection and confidentiality. Please know that we consider the confidentiality of patient information to be of utmost importance. 5. Will my personal information be kept confidential? Yes. Independence Blue Cross and Inovalon take patient privacy very seriously and will take steps to protect your health information and make sure that it remains confidential. 6. Who is going to receive or see my information? The information collected by Inovalon at the time of the exam will be provided to you, your doctor, and to Independence Blue Cross. 7. Am I required to participate in the Personal Health Visit? No, this is a voluntary program. We believe this assessment assists your regular doctor in providing a high level of quality care. If you are more comfortable seeing your doctor, let us know if we can help you schedule an appointment. 8. Does the medical professional have anyone else present while they perform the examination? Usually, only one medical professional will be present for the assessment. You are welcome to have a friend, spouse, family member, or other caregiver present during the assessment. 9. Do I need to have another person while the assessment takes place? This is not required, however, if it would make you feel more comfortable, you are welcome to have a friend, spouse, family member, or other caregiver present during the assessment.

3 10. Can I select the gender of the medical professional? Inovalon will do its best to accommodate your preferences about the gender of the medical professional that performs the exam. Please contact Inovalon directly at Monday through Friday, 8 a.m. to 7 p.m. EST. 11. How much does this cost? This Personal Health Visit is free of charge to you and there is no copayment. 12. Who is paying for this assessment? Independence Blue Cross is paying for this assessment. 13. How will this impact my benefits? Will this increase my premiums? This assessment will not impact your benefits or premiums. 14. How much time will this assessment take? You can expect the assessment to take approximately one hour to complete. 15. What do I do after the assessment? Should I call my doctor? We encourage you to call your doctor two to four weeks after your Personal Health Visit to review the results of this assessment and to discuss your treatment plan. Because your doctor will receive a copy of the results of this assessment, you may receive a call from your doctor. 16. When can I expect to receive a follow-up call from my doctor on the assessment? Will I be able to see the results? We recommend that you contact your doctor two to four weeks after your Personal Health Visit to ensure he/she has received a copy of the results and to see if you should schedule an office visit. The medical professional who performs the assessment will leave behind a summary of the results. 17. Are background checks done on the person performing the assessment? Yes. Extensive background checks are done on every person in our organization. The medical professional performing your assessment has had a thorough background check that includes screening criminal, clinical, license, malpractice, and substance abuse history. 18. Will I be asked to sign anything? You will be required to show you are a member of the health plan and you will need to sign a copy of the assessment summary. 19. How will I know that the person I am meeting with is from a legitimate business associate of Independence Blue Cross? When scheduling an in-home Personal Health Visit, you will get the name of the medical professional. When the in-home Personal Health Visit occurs, the medical professional will show you his or her professional ID card. For walk-in clinic settings, when the Personal Health Visit occurs, the medical professional will have a name badge that clearly displays his or her credentials.

4 20. How can I schedule an appointment? You can call Inovalon to schedule your appointment, toll-free at: (TTY/TDD: ) Monday Friday, 8 a.m.to 7 p.m EST. 21. How soon will I need to have this assessment done? Inovalon will have a select number of available appointments for you to choose from based on your availability. 22. I need to reach the person who called to schedule the Personal Health Visit (to reschedule the appointment, cancel, etc.). How can I reach them and what hours are they available? You can call Inovalon at at Monday through Friday, 8 a.m. to 7 p.m. EST. 23. I do not want to participate in this program. How can I ensure I am not contacted by Inovalon? Please contact Inovalon and state that you do not want to participate. Personal Health Visits at Walk-in Clinics These are Frequently Asked Questions about the Inovalon Personal Health Visit program offered to Independence Blue Cross members at several local walk-in clinics. 1. How much does the Personal Health Visit cost? Will it cost more for me to go to a walk-in clinic location? There will be no cost to you for the Personal Health Visit at any location. 2. Will the members who visit walk-in clinics for a Personal Health Visit receive takeaways after the visit? What will they be? Members will receive member-specific clinical information similar to what is currently provided during an in-home Personal Health Visit. 3. Will my primary care provider (PCP) be notified that I had a Personal Health Visit at a walk-in clinic location? Will my PCP be offered the documentation? Yes. After the Personal Health Visit is completed, a fax with the details of the visit will be sent to your PCP. 4. How will I know which walk-in clinic location to visit? Will I get directions to, and a confirmation of, the appointment? All members will be notified of the address of the walk-in clinic location during the scheduling call as well during a follow-up reminder phone call.

5 Independence Blue Cross Medicare Advantage Member Incentive FAQs 1. What are my gift card options for completing the Personal Health Visit? For a complete list of gift card options, please call Inovalon toll-free at (TTY/TDD: ) Monday Friday, 8 a.m. to 7 p.m EST. 2. When will I receive my gift card? Your gift card should arrive within days of completing your Personal Health Visit. 3. Who do I call if I don t receive my gift card on time? Call GiftCard for customer service. 4. Can I receive cash instead? Independence Blue Cross is not permitted to offer cash for participation in this program. Center for Medicare and Medicaid Services (CMS) prohibits Independence Blue Cross from offering cash as a program incentive. 5. Can I get cash back from the store? Gift cards cannot be redeemed for cash. 6. Instead of a gift card, can I receive $50 towards my premium or copays? Independence Blue Cross is not permitted to offer premium or copay reductions for participation in this program. Center for Medicare and Medicaid Services (CMS) prohibits Independence Blue Cross from offering a reduced premium or copays for participation in this program. 7. Can I choose a different kind of gift card? These options have been carefully selected to cover a wide range of services and products. At this time, additional gift card options are not available. 8. Will this cost me anything? The card is a gift from Independence Blue Cross for completion of the Personal Health Visit and comes at no cost to you. 9. Will the card expire? In most cases, the gift card will not expire, and you will be able to use the gift card until the entire $50 value has been spent. However, this is up to the merchant s discretion, and terms and conditions may change at any time. Please check directly with the merchant or read the terms and conditions on the back of your card upon receipt. 10. How do I activate my card? No activation is required. Once you receive your gift card, it will be ready for use.

6 11. Can I change my gift card option? You can call Inovalon to change your gift card option up to the day before your appointment. 12. What if I miss my appointment? You are encouraged to call Inovalon to reschedule if you are unable to make your original appointment time. A gift card will only be sent to you upon successful completion of a Personal Health Visit. 13. Can I receive multiple gift cards in a year? This is an annual program that offers one gift card per member per calendar year. You are eligible to receive a gift card one time per year upon completion of the Personal Health Visit for each calendar year that the gift card program is offered. 14. Can I use the gift card with other offers? In most cases, the gift card can be combined with other offers, such as sales or buy-one-get-one-free offers. However, limitations are up to the discretion of the particular merchant. 15. Can I buy anything in the store using this card? The card can be used for most items in the store. Limitations will be based on the merchant and any restrictions the merchant might have. 16. Can I make purchases online or over the phone? Yes. Your gift card can be used to make purchases online or over the phone. Website and phone number details will be provided to you upon receipt of your gift card, at the discretion of each merchant. 17. How do I check the balance on my gift card? To check the balance on your card, please visit the merchant s website or contact them directly. 18. Other questions regarding terms and conditions of the gift card: You may contact the merchant directly or call GiftCard for customer service. Detailed terms and conditions will also be provided on the back of the gift card. Keystone 65 HMO and Personal Choice 65 PPO are HMO and PPO plans with a Medicare contract. Enrollment in Keystone 65 HMO and Personal Choice 65 PPO depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. Y0041_HM_15_28554b Accepted 2/21/ /15