2015 Summary of Benefits. H0022_SummaryOfBenefits15_Approved

Transcription

1 2015 Summary f Benefits H0022_SummaryOfBenefits15_Apprved

2 H0022_SummaryBenefits15_Apprved Summary f Benefits This is a summary f health services cvered by Buckeye Health Plan MyCare Ohi fr This is nly a summary. Please read the Member Handbk fr the full list f benefits. Buckeye Health Plan MyCare Ohi (Buckeye) is a health plan that cntracts with bth Medicare and Ohi Medicaid t prvide benefits f bth prgrams t enrllees. It is fr peple with bth Medicare and Medicaid. Under Buckeye yu can get yur Medicare and Medicaid services in ne health plan. A Buckeye care manager will help manage yur health care needs. This is nt a cmplete list. The benefit infrmatin is a brief summary, nt a cmplete descriptin f benefits. Fr mre infrmatin cntact the plan r read the Member Handbk. Limitatins, c-pays, and restrictins may apply. Fr mre infrmatin, call Buckeye Member Services r read the Buckeye Member Handbk. Benefits, List f Cvered Drugs, pharmacy and prvider netwrks, and/r cpayments may change frm time t time thrughut the year and n January 1 f each year. Cpays fr prescriptin drugs may vary based n the level f Extra Help yu receive. Please cntact the plan fr mre details. Yu can ask fr this infrmatin in ther frmats, such as Braille r large print. Call The call is free. Yu can get this infrmatin fr free in ther languages. Call The call is free. Usted puede btener esta infrmación de frma gratuita en trs idimas. Llame La llamada es gratuita. infrmatin, visit 1

3 The fllwing chart lists frequently asked questins. Frequently Asked Questins (FAQ) What is a MyCare Ohi Plan What is a Buckeye care manager What are lng-term services and supprts Will yu get the same Medicare and Medicaid benefits in Buckeye that yu get nw Answers A MyCare Ohi Plan is an rganizatin made up f dctrs, hspitals, pharmacies, prviders f lng-term services, and ther prviders. It als has care teams and care managers t help yu manage all yur prviders and services. They all wrk tgether t prvide the care yu need. A Buckeye care manager is ne main persn fr yu t cntact. This persn helps manage all yur prviders and services and makes sure yu get what yu need. Lng-term services and supprts are help fr peple wh need assistance t d everyday tasks like taking a bath, getting dressed, making fd, and taking medicine. Mst f these services are prvided at yur hme r in yur cmmunity but culd be prvided in a nursing hme r hspital. Yu will get yur cvered Medicare and Medicaid benefits directly frm Buckeye. Yu will wrk with a care team wh will help determine what services will best meet yur needs. This means that sme f the services yu get nw may change. Yu will get almst all f yur cvered Medicare and Medicaid benefits directly frm Buckeye, but yu may get sme benefits the same way yu d nw, utside f the plan. When yu enrll in Buckeye, yu and yur care team will wrk tgether t develp an Individualized Care Plan t address yur health and supprt needs. When yu jin ur plan, if yu are taking any Medicare Part D prescriptin drugs that Buckeye des nt nrmally cver, yu can get a temprary supply. We will help yu get anther drug r get an exceptin fr Buckeye t cver yur drug, if medically necessary. infrmatin, visit 2

4 Frequently Asked Questins (FAQ) Can yu g t the same dctrs yu see nw What happens if yu need a service but n ne in Buckeye s netwrk can prvide it Where is Buckeye available Answers Often that is the case. If yur prviders (including dctrs, therapists, and pharmacies) wrk with Buckeye and have a cntract with us, yu can keep ging t them. Prviders with an agreement with us are in-netwrk. Yu must use the prviders in Buckeye s netwrk. Hwever, this rule des nt apply in sme cases:» If yu need urgent r emergency care r ut-f-area dialysis services, yu can use prviders utside f Buckeye s netwrk.» Yu can see ut-f-netwrk Federally Qualified Health Centers, Rural Health Clinics, and qualified family planning prviders listed in the Prvider and Pharmacy Directry.» If yu are receiving assisted living waiver services r lng-term nursing facility services frm an ut-f-netwrk prvider n and befre the day yu becme a member, yu can cntinue t receive the services frm that ut-f-netwrk prvider. T find ut if yur dctrs are in the plan s netwrk, call Member Services r read Buckeye s Prvider and Pharmacy Directry. Mst services will be prvided by ur netwrk prviders. If yu need a service that cannt be prvided within ur netwrk, Buckeye will pay fr the cst f an ut-f-netwrk prvider. The service area fr this plan includes: Clark, Cuyahga, Fultn, Geauga, Greene, Lake, Lrain, Lucas, Medina, Mntgmery, Ottawa, and Wd cunties in Ohi. Yu must live in ne f these areas t jin the plan. D yu pay a mnthly amunt (als called a premium) under Buckeye What is prir authrizatin Yu will nt pay any mnthly premiums t Buckeye fr yur health cverage. Prir authrizatin means that yu must get apprval frm Buckeye befre yu can get a specific service r drug r see an ut-f-netwrk prvider. Buckeye may nt cver the service r drug if yu dn t get apprval. If yu need urgent r emergency care r ut-f-area dialysis services, yu dn't need t get apprval first. infrmatin, visit 3

5 Frequently Asked Questins (FAQ) Will yu need a referral frm yur PCP t see ther dctrs r specialists What is Extra Help Answers Althugh yu d nt need apprval (called a referral) frm yur Primary Care Prvider (PCP) t see ther prviders, it is still imprtant t cntact yur PCP befre yu see a specialist r after yu have an urgent r emergency department visit. This allws yur PCP t manage yur care fr the best utcmes. Extra Help is a Medicare prgram that helps reduce yur prescriptin drug prgram csts such as cpays. Yur prescriptin drug cpays under Buckeye already include the amunt f Extra Help yu qualify fr. Fr mre infrmatin abut Extra Help, cntact yur lcal Scial Security Office, r call Scial Security at TTY users may call infrmatin, visit 4

6 Frequently Asked Questins (FAQ) Wh shuld yu cntact if yu have questins r need help Answers If yu have general questins r questins abut ur plan, services, billing, r member cards, please call Buckeye Member Services: CALL Calls t this number are free. Hurs f peratin are frm 8 a.m. t 8 p.m., seven days a week. Member Services als has free language interpreter services available fr peple wh d nt speak English. TTY 711 This number is fr peple wh have hearing r speaking prblems. Yu must have special telephne equipment t call it. Calls t this number are free. Hurs f peratin are frm 8 a.m. t 8 p.m., seven days a week. If yu have questins abut yur health, please call the nurse advice call line name: CALL , Optin 7. Calls t this number are free. The Nurse Advice Call Line is available 24 hurs a day, 7 days a week, 365 days a year. (nt mdel) TTY 711 This number is fr peple wh have hearing r speaking prblems. Yu must have special telephne equipment t call it. Calls t this number are free. The Nurse Advice Call Line is available 24 hurs a day, 7 days a week, 365 days a year. infrmatin, visit 5

7 Frequently Asked Questins (FAQ) Wh shuld yu cntact if yu have questins r need help (cntinued) Answers If yu need immediate behaviral health services, please call the Behaviral Health Crisis Line: CALL , Optin #1 Calls t this number are free. The Behaviral Health Crisis Line is available 24 hurs a day, 7 days a week, 365 days a year. TTY 711 This number is fr peple wh have hearing r speaking prblems. Yu must have special telephne equipment t call it. Calls t this number are free. The Behaviral Health Crisis Line is available 24 hurs a day, 7 days a week, 365 days a year. infrmatin, visit 6

8 The fllwing chart is a quick verview f what services yu may need, yur csts and rules abut the benefits. Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Yu want t see a dctr Visits t treat an injury r illness $0 Services that d nt require a referral r prir authrizatin are: PCP visits Emergency Care Urgently-Needed-Care visits Pdiatry visits Chirpractic visits Wellness visits, such as a physical $0 N authrizatin required. Transprtatin t a dctr s ffice $0 Prir authrizatin required. Cntact plan fr details. Specialist care $0 N referral required. Care t keep yu frm getting sick, such as flu shts Welcme t Medicare preventive visit (ne time nly) $0 N referral r authrizatin required. $0 N referral r authrizatin required. The visit includes a review f yur health, as well as educatin and cunseling abut the preventive services yu need including certain screenings and shts. Yu will need a referral fr ther services if needed. Yu need medical tests Lab tests, such as bld wrk $0 Referral may be required. infrmatin, visit 7

9 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) X-rays r ther pictures, such as CAT scans Screening tests, such as tests t check fr cancer $0 Prir authrizatin may be required fr utpatient diagnstic prcedures, tests, X- rays, and therapeutic services $0 Medicare apprved Preventive Screenings d nt require a referral r prir authrizatin. Hwever, it is best t ntify ur plan when Diagnstic tests are scheduled t ensure n authrizatin is required. infrmatin, visit 8

10 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Yu need drugs t treat yur illness r cnditin Generic drugs (n brand name) $0 fr a 30-day supply. $0 fr a 90-day supply There may be limitatins n the types f drugs cvered. Please see Buckeye s List f Cvered Drugs (Drug List) fr mre infrmatin. May need prir authrizatin. Fr sme drugs, yu can get a lng-term supply (als called an extended supply ) when yu fill yur prescriptin thrugh a retail r mail-rder pharmacy. A lng-term supply is up t a 90-day supply. It csts yu the same as a ne-mnth supply. Yu need drugs t treat yur illness r cnditin (cntinued) Brand name drugs $0 t $6.60 fr a 30- day supply. $0 t $6.60 fr a 90- day supply. Cpays fr prescriptin drugs may vary based n the level f Extra Help yu receive. Please cntact the plan fr mre details. There may be limitatins n the types f drugs cvered. Please see Buckeye s List f Cvered Drugs (Drug List) fr mre infrmatin. May need prir authrizatin. Please refer t ur List f Drugs t view thse drugs available fr an extended day supply. Fr sme drugs, yu can get a lng-term supply (als called an extended supply ) when yu fill yur prescriptin. A lng-term supply is up t a 90-day supply. It csts yu the same as a ne-mnth supply. infrmatin, visit 9

11 Health need r prblem Yu need drugs t treat yur illness r cnditin (cntinued) Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Over-the-cunter drugs $0 There may be limitatins n the types f drugs cvered. Please see Buckeye s List f Cvered Drugs (Drug List) fr mre infrmatin. Our plan prvides $70 per calendar quarter fr cvered Over-the-Cunter (OTC) items. OTC items cvered by the benefit are limited t items that are cnsistent with current CMS guidance. Unused amunts may nt be carried ver frm ne calendar quarter t the next calendar quarter. OTC items are available thrugh mail rder. Please cntact the plan fr a list f cvered OTC items and fr instructins n hw t rder OTC items. Medicare Part B prescriptin drugs $0 Part B drugs include drugs given by yur dctr in his r her ffice, sme ral cancer drugs, and sme drugs used with certain medical equipment. Read the Member Handbk fr mre infrmatin n these drugs. Prir authrizatin may be required. Yu need therapy after a strke r accident Occupatinal, physical, r speech therapy $0 Prir authrizatin required. infrmatin, visit 10

12 Health need r prblem Yu need emergency care Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Emergency rm services $0 Emergency rm services d nt require a referral r prir authrizatin and can be prvided at an in-r ut-f-netwrk facility. Nt cvered utside the U.S. and its territries except under limited circumstances. Ambulance services $0 Emergent ambulance services d nt require a referral r prir authrizatin and can be prvided by an in-r ut-f-netwrk prvider. Prir authrizatin is required fr medically necessary nn-emergent ambulance services. Urgent care $0 Urgent Care Services d nt require a referral r prir authrizatin. Urgently needed care may be furnished by innetwrk prviders r ut-f-netwrk prviders when netwrk prviders are temprarily unavailable r inaccessible. Yu need hspital care Hspital stay $0 Except in an emergency, yur dctr must tell the plan yu are ging t be admitted t the hspital. Yu need help getting better r have special health needs Dctr r surgen care $0 During a hspital stay, Dctr and surgen care are cvered and des nt require prir authrizatin. Rehabilitatin services $0 Medical equipment at hme $0 Skilled nursing care $0 Prir authrizatin required. Prir authrizatin required. Prir authrizatin required. infrmatin, visit 11

13 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Yu need eye care Eye exams $0 The plan cvers the fllwing services: One cmprehensive eye exam:» per 12-mnth perid fr members under 21 and ver 59 years f age; r» per 24-mnth perid fr members 21 thrugh 59 years f age. Services fr the diagnsis and treatment f diseases and injuries f the eye, including but nt limited t:» Treatment fr age-related macular degeneratin» One glaucma screening each year fr members under the age f 20 r age 50 and lder, members with a family histry f glaucma, and members with diabetes infrmatin, visit 12

14 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Glasses r cntact lenses $0 The plan cvers the fllwing services: Eyeglasses (frames and lenses):» One pair per 12-mnth perid fr members under 21 and ver 59 years f age; r» One pair per 24-mnth perid fr members 21 thrugh 59 years f age. One pair f glasses r cntact lenses after each cataract surgery when the dctr inserts an intracular lens. (If yu have tw separate cataract surgeries, yu must get ne pair f glasses after each surgery. Yu cannt get tw pairs f glasses after the secnd surgery, even if yu did nt get a pair f glasses after the first surgery.) The plan will als cver crrective lenses, and frames, and replacements if yu need them after a cataract remval withut a lens implant. infrmatin, visit 13

15 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Yu need dental care Dental check-ups $0 The plan cvers the fllwing services: Cmprehensive ral exam and cleaning nce every 180 days fr members under 21 years f age, and nce every 365 days fr members age 21 and lder Preventive services including prphylaxis, fluride, sealants, and space maintainers Rutine radigraphs/diagnstic imaging (ne per year) Cmprehensive dental services including nn-rutine diagnstic, restrative, enddntic, peridntic, prsthdntic, rthdntic, and surgery services Yu need hearing/auditry services Hearing screenings $0 The plan cvers the fllwing: Hearing and balance tests t determine the need fr treatment (cvered as utpatient care when yu get them frm a physician, audilgist, r ther qualified prvider) infrmatin, visit 14

16 Health need r prblem Yu have a chrnic cnditin, such as diabetes r heart disease Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Hearing aids $0 Hearing aids, batteries, and accessries (including repair and/r replacement)» Cnventinal hearing aids are cvered nce every 4 years» Digital/prgrammable hearing aids are cvered nce every 5 years Services t help manage yur disease $0 N prir authrizatin required fr Diabetes nutritin management training. Care Management Prgrams are available fr peple with chrnic cnditins. Cntact yur Care Manager fr mre infrmatin. Yu have a mental health cnditin Yu have a substance abuse prblem Yu need lng-term mental health services Yu need durable medical equipment (DME) Diabetes supplies and services $0 Therapeutic shes r inserts are cvered when medically necessary. Diabetes supplies and services may be limited t specific manufacturers, prducts, and/r brands. Cntact plan fr list f cvered supplies. Mental r behaviral health services $0 Prir authrizatin required. Substance abuse services $0 Prir authrizatin required. Inpatient care fr peple wh need mental health care $0 Prir authrizatin required. Wheelchairs $0 Prir authrizatin required. May be limited t specific manufacturers, prducts, and/r brands. Cntact plan fr list f cvered supplies. infrmatin, visit 15

17 Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Canes $0 Prir authrizatin may be required. Crutches $0 Prir authrizatin may be required. Walkers $0 Prir authrizatin may be required. Oxygen $0 Prir authrizatin required fr medically necessary services. May be limited t specific manufacturers, prducts, and/r brands. Cntact plan fr list f cvered supplies. infrmatin, visit 16

18 Health need r prblem Yu need help living at hme Yu need a place t live with peple available t help yu Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Meals brught t yur hme $0 These services are available nly if yur need fr lng-term care has been $0 determined by Ohi Medicaid. Hme services, such as cleaning r husekeeping Changes t yur hme, such as ramps and wheelchair access Persnal care assistant (Yu may be able t emply yur wn assistant. Cntact yur Care Manager r Waiver Services Crdinatr fr mre infrmatin.) $0 $0 Cmmunity transitin services $0 Hme health care services $0 Services t help yu live n yur wn Adult day services r ther supprt services $0 $0 Yu may be respnsible fr paying a patient liability fr nursing facility r waiver services that are cvered thrugh yur Medicaid benefit. The Cunty Department f Jb and Family Services will determine if yur incme and certain expenses require yu t have a patient liability. These services are designed t meet the needs f members 18 years r lder, wh are fully eligible fr bth Medicare and Medicaid, enrlled in a MyCare Ohi Plan, and wh are determined by the State f Ohi, r its designee, t meet an intermediate r skilled level f care. These services help individuals t live and functin independently. Assisted living $0 These services are available nly if yur need fr lng-term care has been determined by Ohi Medicaid. Nursing hme care $0 Yu may be respnsible fr paying a patient liability fr nursing facility r waiver services that are cvered thrugh yur Medicaid benefit. The Cunty Department f Jb and Family Services will determine if yur incme and certain expenses require yu t have a patient liability. infrmatin, visit 17

19 Health need r prblem Yur caregiver needs sme time ff Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Respite care $0 This service is available nly if yur need fr lng-term care has been determined by Ohi Medicaid. Yu may be respnsible fr paying a patient liability fr nursing facility r waiver services that are cvered thrugh yur Medicaid benefit. The Cunty Department f Jb and Family Services will determine if yur incme and certain expenses require yu t have a patient liability. infrmatin, visit 18

20 Services that Buckeye des nt cver This is nt a cmplete list. Call Member Services t find ut abut ther excluded services. Services nt cvered by Buckeye Services cnsidered nt reasnable and necessary, accrding t the standards f Medicare and Medicaid, unless these services are listed by ur plan as cvered services. Experimental medical and surgical treatments, items, and drugs, unless cvered by Medicare r under a Medicare-apprved clinical research study r by ur plan. Experimental treatment and items are thse that are nt generally accepted by the medical cmmunity. Surgical treatment fr mrbid besity, except when it is medically needed and Medicare cvers it. A private rm in a hspital, except when it is medically needed. Fees charged by yur immediate relatives r members f yur husehld. Elective r vluntary enhancement prcedures r services (including weight lss, hair grwth, sexual perfrmance, athletic perfrmance, csmetic purpses, anti-aging and mental perfrmance), except when medically necessary. Reversal f sterilizatin prcedures, sex change peratins, and nnprescriptin cntraceptive supplies. Services received withut an authrizatin, when an authrizatin is required fr getting that service. Csmetic surgery r ther csmetic wrk, unless it is needed because f an accidental injury r t imprve a part f the bdy that is nt shaped right. Hwever, the plan will cver recnstructin f a breast after a mastectmy and fr treating the ther breast t match it. Chirpractic care, ther than diagnstic x-rays and manual manipulatin (adjustments) f the spine t crrect alignment cnsistent with Medicare and Medicaid cverage guidelines. Rutine ft care, except fr the limited cverage prvided accrding t Medicare and Medicaid guidelines. Acupuncture. Persnal items in yur rm at a hspital r a skilled nursing facility, such as a telephne r a televisin. Services prvided t veterans in Veterans Affairs (VA) facilities. Hwever, when emergency services are received at VA hspital and the VA cst sharing is mre than the cst sharing under ur plan, we will reimburse veterans fr the difference. Members are still respnsible fr ur cst-sharing amunts. Naturpath services (uses natural r alternative treatments). Services that yu get frm nn-plan prviders, except fr care a medical emergency and urgently needed care, renal (kidney) dialysis services that yu get when yu are temprarily utside the Buckeye Health Plan MyCare Ohi service area. infrmatin, visit 19

21 Services nt cvered by Buckeye Inpatient hspital custdial care. Emergency facility services fr nn-authrized, rutine cnditins that are nt a medical emergency. Infertility services fr males r females. Vluntary sterilizatin if under 21 years f age r legally incapable f cnsenting t the prcedure. Abrtins, except in the case f a reprted rape, incest, r when medically necessary t save the life f the mther. Supprtive devices fr the feet, except fr rthpedic r therapeutic shes fr peple with diabetic ft disease. Orthpedic shes, unless the shes are part f a leg brace and are included in the cst f the brace, r the shes are fr a persn with diabetic ft disease. LASIK surgery. Paternity testing. Services t find cause f death (autpsy). infrmatin, visit 20

22 Yur rights as a member f the plan As a member f Buckeye, yu have certain rights. Yu can exercise these rights withut being punished. Yu can als use these rights withut lsing yur health care services. We will tell yu abut yur rights at least nce a year. Fr mre infrmatin n yur rights, please read Chapter 8 the Member Handbk. Yur rights include, but are nt limited t, the fllwing: Yu have a right t respect, fairness and dignity. This includes: The right t get cvered services withut cncern abut race, ethnicity, natinal rigin, religin, gender, age, mental r physical disability, sexual rientatin, genetic infrmatin, ability t pay, r ability t speak English The right t request infrmatin in ther frmats (e.g., audi CD ROM, large print, cassette, Braille) The right t be free frm any frm f restraint r seclusin The right nt t be billed by netwrk prviders Yu have the right t get infrmatin abut yur health care. This includes infrmatin n treatment and yur treatment ptins. This infrmatin shuld be in a frmat yu can understand. These rights include getting infrmatin n: Descriptin f the services we cver Hw t get services Hw much services will cst yu Names f health care prviders and care managers Yu have the right t make decisins abut yur care, including refusing treatment. This includes the right: T chse a Primary Care Prvider (PCP) and yu can change yur PCP at any time T see a wmen s health care prvider withut a referral T get yur cvered services and drugs quickly T knw abut all treatment ptins, n matter what they cst r whether they are cvered T refuse treatment, even if yur dctr advises against it T stp taking medicine T ask fr a secnd pinin. Buckeye will pay fr the cst f yur secnd pinin visit Yu have the right t timely access t care that des nt have any cmmunicatin r physical access barriers. This includes the right t: Get medical care timely Get in and ut f a health care prvider s ffice. This means barrier free access fr peple with disabilities, in accrdance with the Americans with Disabilities Act Have interpreters t help with cmmunicatin with yur dctrs and yur health plan Yu have the right t seek emergency and urgent care when yu need it. This means: Yu have the right t get emergency services withut prir apprval in an emergency infrmatin, visit 21

23 Yu have the right t see an ut f netwrk urgent r emergency care prvider, when necessary Yu have a right t cnfidentiality and privacy. This includes: The right t ask fr and get a cpy f yur medical recrds in a way that yu can understand and t ask fr yur recrds t be changed r crrected The right t have yur persnal health infrmatin kept private Yu have the right t make cmplaints abut yur cvered services r care. This includes the right t: File a cmplaint r grievance against us r ur prviders Ask fr a state fair hearing Get a detailed reasn fr why services were denied Fr mre infrmatin abut yur rights, yu can read the Buckeye Member Handbk. If yu have questins, yu can als call Buckeye Member Services. infrmatin, visit 22

24 If yu have a cmplaint r think we shuld cver smething we denied If yu have a cmplaint r think Buckeye shuld cver smething we denied, call Buckeye at Yu may be able t appeal ur decisin. Fr questins abut cmplaints and appeals, yu can read Chapter 9 f the Buckeye Member Handbk. Yu can als call Buckeye Member Services. Yu can cntact Member Services at frm 8 a.m. t 8 p.m., seven days a week. TTY users call 711. This call is free. Yu can als mail the frm at the end f Chapter 9 f the Member Handbk r send us a letter t: Buckeye Health Plan MyCare Ohi 4349 Eastn Way, Suite 200 Clumbus, OH If yu suspect fraud Mst health care prfessinals and rganizatins that prvide services are hnest. Unfrtunately, there may be sme wh are dishnest. If yu think a dctr, hspital r ther pharmacy is ding smething wrng, please cntact us. Call us at Buckeye Member Services. Phne numbers are n the cver f this summary. Or, call Medicare at MEDICARE ( ). TTY users shuld call Yu can call these numbers fr free, 24 hurs a day, 7 days a week. Or, call the Ohi Attrney General's Office at infrmatin, visit 23

25 Multi-language Interpreter Services English: We have free interpreter services t answer any questins yu may have abut ur health r drug plan. T get an interpreter, just call us at Smene wh speaks English/Language can help yu. This is a free service. Spanish: Tenems servicis de intérprete sin cst algun para respnder cualquier pregunta que pueda tener sbre nuestr plan de salud medicaments. Para hablar cn un intérprete, pr favr llame al Alguien que hable españl le pdrá ayudar. Este es un servici gratuit. Chinese Mandarin: 我 们 提 供 免 费 的 翻 译 服 务, 帮 助 您 解 答 关 于 健 康 或 药 物 保 险 的 任 何 疑 问 如 果 您 需 要 此 翻 译 服 务, 请 致 电 我 们 的 中 文 工 作 人 员 很 乐 意 帮 助 您 这 是 一 项 免 费 服 务 Chinese Cantnese: 您 對 我 們 的 健 康 或 藥 物 保 險 可 能 存 有 疑 問, 為 此 我 們 提 供 免 費 的 翻 譯 服 務 如 需 翻 譯 服 務, 請 致 電 我 們 講 中 文 的 人 員 將 樂 意 為 您 提 供 幫 助 這 是 一 項 免 費 服 務 Tagalg: Mayrn kaming libreng serbisy sa pagsasaling-wika upang masagt ang anumang mga katanungan niny hinggil sa aming planng pangkalusugan panggamt. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa Maaari kayng tulungan ng isang nakakapagsalita ng Tagalg. It ay libreng serbisy. French: Nus prpsns des services gratuits d'interprétatin pur répndre à tutes vs questins relatives à ntre régime de santé u d'assurance-médicaments. Pur accéder au service d'interprétatin, il vus suffit de nus appeler au Un interlcuteur parlant Français purra vus aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kstenlser Dlmetscherservice beantwrtet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dlmetscher erreichen Sie unter Man wird Ihnen drt auf Deutsch weiterhelfen. Dieser Service ist kstenls. H0022_MultiLangInsert15_Apprved infrmatin, visit 24

26 Krean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 번으로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다. Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. إننا نقدم خدمات المترجم الفوري المجانية لإلجابة عن أي أسئلة تتعلق بالصحة أو جدول األدوية لدينا. للحصول على مترجم فوري ليس عليك سوى االتصال بنا على Arabic:.بمساعدتك. ھذه خدمة مجانية سيقوم شخص ما يتحدث العربية Hindi: हम र व य य दव क य जन क ब र म आपक कस भ प र न क जव ब द न क लए हम र प स म त द भ षय स व ए उपल ध ह. एक द भ षय प र त करन क लए, बस हम पर फ न कर. क ई य क त ज ह द ब लत ह आपक मदद कर सकत ह. यह एक म त स व ह. Italian: È dispnibile un servizi di interpretariat gratuit per rispndere a eventuali dmande sul nstr pian sanitari e farmaceutic. Per un interprete, cntattare il numer Un nstr incaricat che parla Italianvi frnirà l'assistenza necessaria. È un servizi gratuit. Prtugués: Dispms de serviçs de interpretaçã gratuits para respnder a qualquer questã que tenha acerca d nss plan de saúde u de medicaçã. Para bter um intérprete, cntacte-ns através d númer Irá encntrar alguém que fale idima Prtuguês para ajudar. Este serviç é gratuit. French Crele: Nu genyen sèvis entèprèt gratis pu repnn tut kesyn u ta genyen knsènan plan medikal swa dwòg nu an. Pu jwenn yn entèprèt, jis rele nu nan Yn mun ki pale Kreyòl kapab ede w. Sa a se yn sèvis ki gratis. Plish: Umżliwiamy bezpłatne skrzystanie z usług tłumacza ustneg, który pmże w uzyskaniu dpwiedzi na temat planu zdrwtneg lub dawkwania leków. Aby skrzystać z pmcy tłumacza znająceg język plski, należy zadzwnić pd numer Ta usługa jest bezpłatna. Japanese: 当 社 の 健 康 健 康 保 険 と 薬 品 処 方 薬 プランに 関 するご 質 問 にお 答 えするために 無 料 の 通 訳 サービスがありますございます 通 訳 をご 用 命 になるには にお 電 話 ください 日 本 語 を 話 す 人 者 が 支 援 いたします これは 無 料 のサービスです infrmatin, visit 25

27 Smaali: Waxaan haynaa adeegy turjumaanim bilaash ah si lagaaga jawaab wixii su'aal aad qabt ee la xidhiidha caafimaadkaaga ama qrshahaaga. Si aad u hesh turjumaan, naga s wac lambarka ah Qf ku hadlaya LuqaddaIngiriisida ayaa ku caawin dna. Kani waa adeeg bilaash ah. infrmatin, visit 26

28 4349 Eastn Way, Suite 200 Clumbus, OH Phne: TTY: 711