Your quick reference guide to good health.

Transcription

1 Your quick reference guide to good health. HealthSpan HMO Handbook

2 Greetings from HealthSpan You re starting off on the right foot with the HealthSpan HMO plan. We re glad to be your partner on this journey, and we look forward to a long and healthy relationship with you. To help you make the most of your membership, you will be receiving your HealthSpan ID card and your Evidence of Coverage document shortly. The Evidence of Coverage contains important information about your benefits, copayments, limitations and services and takes precedence over this document. This handbook will walk you through the most important steps toward maximizing your membership. You can get even more out of your health plan by registering on healthspan.org/myhealthmanager. Please note that on October 1, 2013, Kaiser Permanente Ohio became HealthSpan. For a certain period of time, as we work to fully transition our online presence to healthspan.org, you may be redirected to the Kaiser Permanente website (kp.org) for information and resources including access to your electronic medical record, My Health Manager. Please continue to log onto kp.org to manage the care you receive at our Northeast Ohio medical offices. Take advantage of all that life has to offer by being as healthy as you can be. Welcome to HealthSpan! Ken Page, President, HealthSpan Integrated Care Nabil Chehade, MD, President, HealthSpan Physicians Some content and documents may reference the Kaiser Permanente brand name, but please note that in Ohio, this content now applies to HealthSpan Integrated Care.

3 This is the start of something good Get Acquainted Having the right personal physician is important for your good health. If you need to find a new physician, we ll point you in the right direction. And scheduling an appointment is as easy as making a simple phone call. Get Connected Make the most out of your health by knowing how to access the care and services you need. Get familiar with our HealthSpan medical offices, how to look up network providers, and more. Get in the Know Like they say, knowledge is power. Learn about the other levels of care available to you when you need them. Get in Touch A quick reference guide for all of the phone numbers and addresses you may need to get the most out of your health plan. Get to Know Your Rights and Responsibilities We are partners in your health care. Learn about your rights as a member as well as your responsibilities.

4 Table of Contents Get Acquainted Overview... 3 Choosing your Primary Care Physician... 4 Transition your Prescriptions... 4 Get Connected Coordinate your care... 6 Electronic Medical Record System... 6 Types of Health Care Visits... 8 Get in the Know Make the best of your benefits Care is a phone call away Get in Touch Important Phone Numbers HealthSpan Medical Offices Get to Know Your Rights and Responsibilities Your Rights as a Member Your Responsibilities as a Member Advance Directives for Health Care

5 Overview We want you to understand and feel comfortable with your health related needs and decisions. The more you learn about our quality care, the more confident you can feel about your HealthSpan membership. Your HealthSpan health plan covers outpatient services, hospital stays, and medically necessary treatments. To receive benefits, you need to obtain care from a HealthSpan physician or from a contracted network health provider. This Member Handbook is an overview of your benefits, and your Evidence of Coverage/Certificate of Insurance always takes precedence over the Handbook. If there is a conflict between this Handbook and your Evidence of Coverage/ Certificate of Insurance, the Evidence of Coverage/Certificate of Insurance controls. For more specific information about which services are covered, refer to your Evidence of Coverage. If you have questions or haven t received your Evidence of Coverage yet, please call Customer Relations at (216) or For TTY users, call (216) or

6 get acquainted Start a healthy relationship. Having your choice of personal physicians means you can find the right doctor for you. Look for the right kind of practitioner You may already have a primary care physician (PCP) who accepts HealthSpan health plans. If you need to find a new physician, we ll help you choose wisely. Your primary care physician is your health care advocate, committed to working with you to help you achieve and maintain good health over the long term. Please keep in mind that your primary care doctor choice will determine where you receive covered specialty care. By referring only to a select group of specialty care physicians, your primary care physician is better able to coordinate and oversee your medical care. The following types of doctors can provide you and your family with primary care. Each member of your family can have a different doctor, or you can choose to have the same family practitioner. Adults Choose a doctor from Children and Teens Choose a doctor from Adult Medicine/ Internal Medicine These doctors include general practitioners and/or internists who may have particular areas of focus. Family Medicine Family practitioners care for people of all ages, and often for members of the same family. They may also provide general gynecologic care for women. Pediatrics Pediatricians care for infants, children, adolescents, and teens. Obstetrics-Gynecology This department provides comprehensive gynecologic and obstetric care. Women 18 to 64 should choose an ob-gyn in addition to a personal physician. We enourage teen girls to choose an ob-gyn, too. Transitioning your prescriptions If you re currently taking prescription medications, be sure to transition your prescriptions to a HealthSpan pharmacy or a network pharmacy. For help, call Customer Relations at (216) or For TTY users, call (216) or

7 Choose your primary care physician You can choose your primary care physician from HealthSpan Physicians, as well as network providers. Please reference the HealthSpan HMO/Tier One Provider Directory for a complete listing of HealthSpan Physicians and network providers. For the most up-to-date list of physicians, visit healthspan.org/locations. You may change primary care physicians once a month for any reason as long as the new physician is accepting new patients. To choose or change your primary care physcian, follow the steps below. by phone To choose your doctor online To choose your doctor Call Member Services Our physician selection specialists are available Monday through Friday, from 8 a.m. to 5 p.m. at (or TTY ). They ll talk to you about your needs and help you make your choice. Go to healthspan.org/locations A complete listing of primary care physicians is available via printable PDFs located on the healthspan.org website. For a limited time, you may also visit kp.org/facilities where you can perform a search by practitioner name, office location, gender, language, and medical specialty. Schedule an appointment If you ve chosen a network provider, call your doctor s office directly to schedule an appointment. To schedule an appointment at a HealthSpan medical office, call (or TTY ) seven days a week, 24 hours a day. Canceling an appointment If you ve chosen a network provider, call your doctor s office directly to cancel an appointment. To cancel an appointment at a HealthSpan medical office, call (216) or , seven days a week, 24 hours a day. Transferring medical records If you are seeing a HealthSpan primary care physician for the first time and need to transfer your medical records from a previous physician s office, you can wait until your first appointment and fill out an authorization form which will allow HealthSpan to obtain the records for you. Or you can contact your previous physician s office directly and have them mail your medical records to: HealthSpan, c/o Medical Correspondence, 5410 Lancaster Drive, Brooklyn Heights, OH Make sure your new medical record number is written on the top of your records. 5

8 get connected Keep the conversation going. Being connected to your care team can put you in touch with your health and wellness. What it means to be well connected When you receive care at a HealthSpan facility we store your health information electronically instead of in paper files. When you need care, your health care team accesses your electronic medical record through our secure computer network. Every HealthSpan medical office is linked to your electronic medical record so whenever you go to one of our medical office buildings, you know you ll get personalized care. HOW YOUR HEALTH INFORMATION TRAVELS Your doctor s office Your electronic medical record is updated with each visit, whether you see your personal physician or another member of your care team. From department to department and medical office to medical office, your record goes where you go. pharmacy Get your prescriptions at any HealthSpan pharmacy or a network pharmacy. You can also order maintenance medications for ongoing conditions through our Direct Mail Pharmacy service at , Monday through Friday, from 9 a.m. to 5 p.m. You can also order your prescription online. The maximum expected turnaround for the processing and shipment of all prescriptions by the Direct Mail Pharmacy is two weeks. Electronic MEDICAL record Laboratory and X-Ray You can have routine lab work and radiology services completed at some HealthSpan medical offices. Contact the facility directly to schedule these services. 6

9 Accessing your electronic health record Please note that on October 1, 2013, Kaiser Permanente Ohio became HealthSpan. For a certain period of time, as we work to fully transition our online presence to healthspan.org, you may be redirected to the Kaiser Permanente website (kp.org) for information and resources including access to your electronic medical record, My Health Manager. Please continue to log onto kp.org to manage the care you receive at our Northeast Ohio medical offices. How to connect to your health from home You have a personal link to your electronic medical record online if you receive care at a HealthSpan medical office. When you register, you can connect to your record through My Health Manager. This set of tools helps you manage your care at HealthSpan medical offices from one appointment to the next. You can also use My Health Manager to act on behalf of a family member. access your record with My Health Manager After your appointment IN BETWEEN APPOINTMENTS FOR YOUR NEXT VISIT Review your visit A summary of your office visit will be available online so you can review important details. your doctor s office If you have a nonurgent question about your health, you can your care team at any time. Track your health Check your health care reminders, see your immunization history, keep tabs on your allergies, and more. See most test results Your results will be posted as soon as they re ready. For some tests, we ll call you with the results. Order Prescription Refills Look up your medication details and order most refills online. You can even have them delivered for no extra charge. Schedule a visit Schedule routine and preventive care visits with your personal physician and nonurgent appointments in other select departments. 7

10 get connected The care you need, when you need it Different health needs require different kinds of care. To better understand those differences, review the chart below. Keep in mind that the examples given are just some of the possible health needs that may fall under each category of care. And of course, if you have an emergency medical condition, call 911 or go to the nearest hospital. What is it for? Routine NonUrgent care An expected care need, like a recommended preventive screening or a visit for a health issue currently being treated. other NonUrgent Care A new health concern or a change in an existing health condition that is not an urgent care need. What should you Know? Examples of routine nonurgent care needs include: Physical exams Pre-travel exams Pap tests Well-child checkups Medication checkups Follow-up visits We encourage you to schedule these appointments with your primary care physician or ob-gyn. Examples of other nonurgent care needs include: Trouble sleeping Digestion problems Skin changes Joint stiffness Anxiety issues Weight loss or gain You can schedule these appointments with your primary care physician or request a consultation with a specialist. What do you do? Make an appointment: Call your doctor s office directly if you have a network provider. Call our appointment line if you see a doctor at a HealthSpan medical office. Make an appointment: Call your doctor s office directly if you have a network provider. Call our appointment line if you see a doctor at a HealthSpan medical office. 8

11 Get advice for an injury or illness If you see a physician at a HealthSpan medical office, call our appointment and advice line at (or TTY ) anytime of the day or night. If you see a network provider and need advice about care, call your doctor s office directly. urgent Care Emergency care An illness or injury that requires prompt medical attention, but is not an emergency medical condition. Examples of urgent care needs include: Minor injuries Sore throats or coughs Earaches Backaches Urinary problems Pink eye Urgent care is available from network providers at several locations throughout Northeast Ohio. You can also visit any HealthSpan medical office that offers after-hours care. The charge for urgent care or afterhours care is typically higher than a regular office visit, but less than an emergency room visit. A medical emergency is when you reasonably believe that your health is in serious danger when every second counts. Examples of emergencies include: Suspected heart attacks Poisonings Severe abdominal pains Severe cuts or burns Fractures Severe asthma attacks An emergency medical condition is a medical or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health, serious impairment to your bodily functions, serious dysfunction of any bodily organ or part, or serious jeopardy to the health of a pregnant woman or her unborn child. Another emergency medical condition is active labor, which means a labor when there is inadequate time for safe transfer to a network hospital (or designated hospital) before delivery or if transfer poses a threat to the health of the member or unborn child. If you have an emergency medical condition, call 911 or go to the nearest hospital. HealthSpan also has Emergency Services available at: HealthSpan Cleveland Heights Medical Center HealthSpan Parma Medical Center Know your options: Call your doctor s office for a same-day appointment or to see if after-hours care is available. Visit healthspan.org/locations to find urgent care locations. Take immediate action: Call 911 or go directly to the nearest Emergency Room. If you seek emergency care and need to be admitted, you, a member of your family, or the admitting physician must notify us either before you are admitted, or if that is not possible, within 24 hours or as soon as medically possible so we can help coordinate your care. If you receive emergency care from a provider outside of the HealthSpan network, and you receive a bill for these services, submit to HealthSpan within 60 days from the date of service. Please review your Evidence of Coverage for additional information. 9

12 get in the know Make the most of your benefits. Understanding how your health plan works can give you a healthy advantage. If you have more complex needs An illness or injury can happen at any time. That s why it s important to be prepared for the unexpected. A great way to do that is to review your Evidence of Coverage so you know how to get the care you need. To see a copy, sign on to My Health Manager. If you have additional questions, call Customer Relations at (216) or For TTY users, call (216) or SELF- REFERRAL SPECIALIST You do not need a referral from your PCP for the following services or specialties: Mammography Flu vaccinations or pneumococcal vaccine Obstetrics/Gynecology Mental health Alcohol/Chemical dependency While no referral is needed for the above services or specialties, it is recommended that you receive care from a specialist who is affiliated with your PCP. Contact Member Support Services at (216) or to verify affiliation. For TTY users, call (216) or Appointments with all other specialists require a referral from your primary care physician. You must speak with your PCP before seeking care from a specialist. He/ she will then consult with Medical Management for approval. Once the referral is approved you will receive a formal, written authorization. Failure to wait for the written approval could result in loss of benefit and increased out of pocket cost to you. REFERRAL SPECIALIST Your referral will be limited to specific services, a specific length of time, or a specific number of visits. If the referral specialist wants to prescribe test, services, or follow-up visits not approved in advance, he or she must get written authorization from your PCP. If additional tests or services are required, you will receive a letter confirming your approved referral. Most tests that an outside specialist might request may be provided within our network. If you need to receive hospital services, your physician needs to call in advance of when you need hospital services. If you do not get these referrals or preauthorizations before getting care, you may be responsible for paying for all, or part, of the services provided. PHARMACY SERVICES HMO members who have a prescription drug benefit may obtain prescriptions from HealthSpan pharmacies or network pharmacies. Pharmacy locations and phone numbers are available starting on page 21. HealthSpan pharmacies also stock many nonprescription products that members can purchase at favorable prices. If you are interested in purchasing any of these products, speak with your pharmacist. 10

13 Care is a phone call away We are committed to providing you with the right care at the right time, in the right place. One phone call can put you in touch with a team dedicated to your needs. 24-HOUR CARE LINE A member of our trained staff is available 24 hours a day to assess your concerns and symptoms and direct you to the most appropriate treatment. Treatment options include the following: Telephone Nurse advice - free Telephone Physician advice - free A same-day appointment with the doctor An urgent care visit A HealthSpan emergency services visit (at Parma Medical Center and Cleveland Heights Medical Center) A hospital emergency department visit A scheduled physician telephone visit - free Care is just a phone call away: Available seven days a week, 24 hours a day Call (216) or TTY Our drug formulary Your HealthSpan HMO Plan prescription drug benefit uses a formulary. A formulary is a list of medications your physician can choose from that will be covered under your prescription drug benefit. The medications included in the HealthSpan drug formulary are chosen by a group of HealthSpan physicians, pharmacists, and nurses know as the Pharmacy and Therapeutics Committee. This committee meets at least six times per year to evaluate and choose those medications that are most effective, safe, and useful in caring for our members. For more information, please contact a HealthSpan pharmacy or Customer Relations. Our Commercial Formulary is updated once a month and posted on our website, healthspan.org/formulary. Please visit this site for the most current list of medications. 11

14 How to Reach Us Get in Touch This section provides many of the phone numbers you may need as a HealthSpan member. If you can t find a phone number that you need, call Customer Relations at (or TTY ). If you need emergency medical assistance, call 911 or go to the nearest emergency room. 24-hour Care Line or (216) (or TTY ) seven days a week, 24 hours a day Call if you have a HealthSpan physician and need to speak with a nurse or physician Appointment Cancellation (216) or (or TTY ) seven days a week, 24 hours a day Automated line for canceling routine appointments with HealthSpan physicians Customer Relations (216) or (or TTY (216) or ) Monday through Thursday, 8:15 a.m. to 5 p.m. and Friday 9 a.m. to 5 p.m. Call to: Discuss health plan questions Questions about your plan benefits, claims, etc. Direct Mail Pharmacy (216) or (or TTY ) seven days a week, 24 hours a day Call to: Order a prescription refill to be mailed to your house Pick up a postage paid envelope at any HealthSpan medical office to sign up for direct mail pharmacy Register on our web site to order refills online Health Education (216) or , Monday through Friday, from 10 a.m. to 4 p.m. To learn about health education classes near you 12

15 Member Service Center (216) or (or TTY (216) or ) seven days a week, 24 hours a day Call to: Schedule an appointment Leave a message for your HealthSpan physician Find the right care available to you, 24 hours a day, seven days a week Member Support Services (216) or (or TTY (216) or ) Monday through Friday, 8 a.m. to 5 p.m. and Saturday 8 a.m. to 12 p.m. Call to: Choose a primary care physician (PCP) Change your primary care physician Questions about a specialist Travel Clinic Monday through Friday, from 10 a.m. to 7 p.m. For medical advice and requirements for traveling abroad, including scheduling vaccinations 13

16 HealthSpan Medical Facilities Get in Touch Find a convenient location With 15 HealthSpan medical offices in Ohio, it s easy to find a doctor who s close to your home or workplace. Many of our medical offices house primary care, laboratory, X-ray, and pharmacy services under one roof so you can visit your personal physician and manage many of your other needs in a single trip. For the most up-to-date hours and services provided for each location, visit healthspan.org/locations. To schedule an appointment or ask for medical advice, please call (TTY ). For pharmacy services, please call HealthSpan Medical Office Buildings 1 Avon Medical Offices Avon Pointe Professional Campus American Way Avon, OH Bedford Medical Offices Rockside Road Bedford, OH Chapel Hill Medical Offices 1260 Independence Avenue Akron, OH Cleveland Heights Medical Center 10 Severance Circle Cleveland Heights, OH Concord Medical Offices 7536 Fredle Drive Concord, OH Fairlawn Medical Offices 4055 Embassy Parkway, Suite 110 Fairlawn, OH Kent Medical Offices 2500 State Route 59, Suite 28 Kent, OH Medina Medical Offices 3443 Medina Road, Suite 108 Medina, OH Mentor Medical Offices 7695 Mentor Avenue Mentor, OH North Canton Medical Offices 4914 Portage Street NW North Canton, OH Parma Medical Center Snow Road Parma, OH Rocky River Medical Offices Center Ridge Road, Suite 500 Rocky River, OH Strongsville Medical Offices Royalton Road Strongsville, OH Twinsburg Medical Offices 8920 Canyon Falls Blvd. Twinsburg, OH Willoughby Medical Offices 5105 S.O.M. Center Road Willoughby, OH

17 HealthSpan Service Area Affiliated Hospitals HealthSpan Medical Offices HealthSpan Medical Office/ Emergency Services The HealthSpan Commercial service area consists of Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark, Summit, and Wayne counties. HealthSpan Medical Facilities Lorain LAKE Medina Lake E RIE Geauga Cuyahoga Summit Portage Avon Medical Offices Avon Wayne Stark 2 Bedford Medical Offices Bedford 3 Chapel Hill Medical Offices Akron 77 4 Cleveland Heights Medical Center Cleveland Heights Affiliated Hospitals (specific services may vary) 5 Concord Medical Offices Concord 6 Fairlawn Medical Offices Fairlawn 7 Kent Medical Offices Kent 8 Medina Medical Offices Medina 9 Mentor Medical Offices Mentor 10 North Canton Medical Offices North Canton 11 Parma Medical Center Parma 12 Rocky River Medical Offices Rocky River 13 Strongsville Medical Offices Strongsville 14 Twinsburg Medical Offices Twinsburg 15 Willoughby Medical Offices Willoughby 16 Akron General Medical Center Akron 17 Children s Hospital Medical Center of Akron Akron 18 Edwin Shaw Rehabilitation Institute Cuyahoga Falls 19 EMH Regional Medical Center Elyria 20 LakeWest Medical Center Willoughby 21 Lodi Community Hospital Lodi 22 Mercy Allen Hospital Oberlin 23 Mercy Medical Center Canton 24 Mercy Regional Medical Center Lorain 25 MetroHealth Medical Center Cleveland 26 Parma Community General Hospital Parma 27 Robinson Memorial Hospital Ravenna 28 TriPoint Medical Center Concord 29 University Hospital Ahuja Medical Center Beachwood 30 University Hospitals Case Medical Center Cleveland 31 University Hospital MacDonald Women s Hospital Cleveland 32 University Hospital Rainbow Babies & Children s Hospital Cleveland 33 University Hospitals Richmond Medical Center Richmond Heights (Inpatient Psychiatric Admissions Only) 34 Windsor Laurelwood Center for Behavioral Medicine Willoughby 15

18 Get to know your rights and responsibilities Rights, Responsibilities And Privacy Your rights as a HealthSpan member You are our partner in your health care. Your participation in decisions about your health care and your willingness to communicate with your physician (practitioner) and other health care professionals help us to provide you appropriate and effective health care. As an adult member, you can exercise these rights yourself. If you are a minor or if you become incapable of making decisions about your health care, these rights will be exercised by the person having legal responsibility for participating in decisions concerning your medical care. You have the right to... Receive information about HealthSpan, its services, the practitioners and providers who provide your health care, and your rights and responsibilities as a HealthSpan member. Be assured of privacy and confidentiality. You have the right to be treated with respect and recognition of your dignity and need for privacy. HealthSpan will not release your medical information without your authorization, except as required or permitted by law. You have the right to review and receive copies of your medical records, unless the law restricts our ability to make them available. Participate with practitioners in your health care and receive the medical information you need to make health care decisions. We will try to make this information as understandable as possible. You have the right to have ethical issues that arise in connection with your health care reviewed. You have the right to accept or refuse a recommended treatment. Emergencies or other circumstances occasionally may limit your participation in a treatment decision. In general, however, you will not receive any medical treatment before you or your legal representative gives consent. You are entitled to an interpreter if you need one. Have a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Use customer satisfaction resources. We welcome your questions and comments about HealthSpan, our services, the practitioners and other health care professionals providing your care, and your rights and responsibilities. You have the right to voice complaints or file appeals without concern that your care will be affected. You have the right to know about the complaints, grievances and appeals procedures. In order to assist you, the Customer Relations staff is available to answer your questions and resolve problems. Make recommendations regarding HealthSpan s members rights and responsibilities policies. Express your wishes concerning future care in an advance directive. You have the right to choose a person to make medical decisions for you if you are unable to do so. Your choices regarding your future care may be expressed in such documents as a durable power of attorney for health care or a living will. You should inform your family and practitioner of your wishes, and give them any documents that describe your choices regarding future care. Have impartial access to medically indicated treatment that is a covered benefit, regardless of your race, religion, sex, sexual orientation, national origin, cultural background, disability, or financial status. You have the right to access emergency health care services for conditions of sufficient severity that a prudent layperson could expect the absence of immediate medical attention to result in serious jeopardy to your health, or serious impairment or dysfunction of bodily functions. Have a safe, secure, clean, and accessible health care environment. 16

19 Participate in physician selection. You have the right to select a physician with an open practice as your primary care practitioner and to change your primary care practitioner at a future date. You have the right to a second opinion by a HealthSpan practitioner. You have the right to consult with a non- HealthSpan practitioner at your own expense. Receive relevant information and education that helps ensure your safety in the course of treatment. Receive information about the outcomes of care you have received, including unanticipated outcomes. Make complaints and receive a summary of information on the appeals and grievances other members have filed in the past. Have prescriptions fulfilled in a timely manner. Receive information about drug coverage and costs. Your responsibilities as a HealthSpan member You have the responsibility to... Provide accurate and complete information about your present and past medical conditions (to the extent possible) that the organization, its practitioners, and providers need in order to provide care. You should report unexpected changes in your condition to your practitioner. Follow the treatment plan to which you and your health care practitioner agree. You should inform your practitioner if you do not clearly understand your treatment plan and what is expected of you. If you believe you cannot follow through with your treatment, you are responsible for telling your practitioner. Understand your health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Know the extent and limitations of your health care benefits. An explanation of these is contained in your Evidence of Coverage. Identify yourself with your member ID card. You are responsible for your membership card, for using it only as appropriate, and for ensuring that other people do not use your card. Keep scheduled appointments or cancel, in a timely manner, any appointments you are unable to keep. You are responsible for promptly canceling any appointment that you don t need or cannot keep. Provide accurate and complete information regarding your current address, your eligibility status, the eligibility status of your dependents and coverage or payments for health services available to you from other sources. Recognize the effect of your lifestyle on your health. Your health depends not just on care provided by HealthSpan, but also on the decisions you make in your daily life. Be considerate of others. You should respect other people and their property as well as the people and property of HealthSpan. Fulfill financial obligations. You should pay on time any money you owe HealthSpan. 17

20 Get to know your rights and responsibilities Advance directives for health care Our members have the right to express their wishes concerning future health care in the event they become incapable of accepting or refusing health care on their own. HealthSpan s policy is to include such advance directives in the medical record and to implement them as permitted by Ohio law. Under Ohio law, such choices may be expressed in advance directives known as the Health Care Power of Attorney or the Living Will. You are not required to initiate an advance directive, and you will not be denied care if you do not have an advance directive. Contact us for an informational packet prepared by the Ohio Hospice & Palliative Care Organization in cooperation with the Ohio State Medical Association, the Ohio Hospital Association, and the Ohio Osteopathic Association. The packet includes instructions and preprinted forms for the Living Will and the Health Care Power of Attorney developed by the Ohio State Bar Association. Please write to: HealthSpan Customer Relations Department P.O. Box 5309 Cleveland, OH You may also call us to request the information packet. Please leave your name and mailing address on the voic at (216) , seven days a week, 24 hours a day and we will send a packet to you. Deaf, hard of hearing, or speech impaired members may call Customer Relations for assistance at (216) or , Monday through Thursday, 8:15 a.m. to 5 p.m. and Friday 9 a.m. to 5 p.m. If you believe your Provider has not complied with your advanced directive, you may file a complaint with HealthSpan by following the HealthSpan Grievance Procedure outlined in your Evidence of Coverage. 18

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24 HealthSpan Integrated Care North Point Tower Suite Lakeside Avenue Cleveland, Ohio Please recycle. This material was produced from eco-responsible resources. # Ready, set, go!