For more information, call health net cal mediconnect member services or read the health net cal mediconnect member handbook. Specific requirements of a members health benefits vary and may differ from the general procedures outlined in this manual. You might not be able to access our systems during this time. Carecare1st health plan member, you have the right to respectful and courteous treatment. Anthem blue cross and blue cross of california partnership plan, inc. State of californiahealth and human services agency. Care health plan member services department tollfree 18888399909 as an l. Read this member handbook to learn more about health care language assistance services, such as interpreter and translation services. The california department of managed health care is responsible for regulating health care service plans.
Care health plan member handbook this member handbook tells you about your coverage under l. Hmo appreciates your confidence and trust in allowing us to manage your health care needs. This member handbook tells you about your coverage under mcp. Jan 27, 2020 bulletins and manuals navigation tool. Many california families may qualify for this free or lowcost option. Proposed agreement to transfer phoenix health plan members to care1st to get prescriptions filled at their current pharmacy as long as it is part of the please use the care1st prior authorization form and follow the care1st prior. Getting started with kaiser permanente medical ver en espanol if you are currently a kaiser permanente member, and are new to medical, you can enjoy the peace of mind of keeping the kaiser permanente doctor you know and trust, and getting the same high quality of care and convenient services you depend on. Care1st department contact information member services will help you with questions or concerns you may have.
If you are not enrolled in blue shield promise medi cal yet, read our potential member materials, you should also read our eligibility and enrollment information. Care1st offers comprehensive coverage, with a large variety of different plans, including highdeductible plan f. The provider manual also contains policies, procedures, regulatorycontractual requirements to support you in providing comprehensive care to our members and understanding our programs and. If you have not received the 14character bic id, contact your local county ofce. Seizing on the massive expansion in medicaid, blue shield of california has agreed to acquire care1st, a monterey parkbased health plan with more than 500,000 patients. Coordinated choice plan hmo h5928037 is a 2018 medicare advantage or medicare partc plan by care1st health plan available to residents in california. It is a summary of anthem rules and policies and based on the contract between anthem and department of health care services dhcs. It will answer many of your questions about services and benefits covered through medi cal and additional programs offered by phc. This document explains your rights, benefits, and responsibilities as a member of molina dual options.
Medical member handbook evidence of coverage mar 30, 2018, 15. Unauthorized or improper use of this system may result in administrative disciplinary. Health net cal mediconnect plan medicaremedicaidplan. Be careful about accepting medical services when you are told they will be free of charge.
California department of health care services model member. Please read your member services guide handbook and keep it in a safe place where you can find it quickly. This member handbook is also called the combined evidence of coverage eoc and disclosure form. The workbooks should be used as a reference for training purposes only. Care1st health plan arizona and onecare medicare health plan. Dental benefits are available to medical members who qualify through dentical provided by the department of health care services dhcs.
Anthem blue cross is the trade name for blue cross of. The contact page includes medi cal resources and health information for individuals, families, children with special medical conditions and seniors needing personal ca. Ncqa is a notforprofit organization dedicated to improving health care. Health net medical member handbook pdf need more help. The benefit information is a brief summary, not a complete description of benefits. The medical member handbook has a complete list of benefits. You may view this member handbook before you enroll in the medical plan. Member handbook evidence of coverage blue shield of ca. This notice will tell you about how we may use and disclose medical information we receive about you.
Health plan recommendations to improve snf repatriation process and ca community transitions. Care1st health plan is a health plan that contracts with both medicare and medi cal to provide benefits of both programs to enrollees. Performance evaluation report care1st partner plan july 1, 2012june 30, 20 medical managed care division california department of health care services april 2014. Covering individuals who are disabled andor over the age of 65.
In this section you will also find other important plan documents, and information on how blue shield of california promise health plan supports its members. If you have special health needs, be sure to read all sections that apply to you. Medical member handbook combined evidence of coverage and. That is why we offer high quality health care through health net medi cal. It also explains your rights and responsibilities as a member of l. Thank you for joining partnership healthplan of california phc. Contact us members care1st health plan arizona, inc. Care cal mediconnect plan member handbook chapt1 getting s tarted as a member 1 if you have questions, please call l. Care care1st health plan member, you have a responsibility to act courteously and respectfully. Medical handbook page 1 santa clara county, california. The medi cal contacts page of the department of health care services website offers important contact information for a variety of recipient resources. You do not have to use a family member or friend as an interpreter. Care, the member may choose to get services through any health plan. To find out what benefits your plan covers, read plan details in your member handbook evidence of coverage.
Blue shield of california promise health plan is a managed care organization, wholly owned by blue shield of california, offering medical, cal mediconnect, medicare advantage hmo, and dual eligible special needs plans dsnp. We can answer questions about your benefits, help you resolve a problem and make sure you get the services you need. Tell care1st member services, your pcp and other care1st. Acupuncture acu audiology and hearing aids aud chiropractic chr durable medical equipment and medical supplies dme medical transportation mtr orthotics and prosthetics oap psychological services psy. Anthem blue cross is the trade name for blue cross of california. Member identification card quick reference guide front of card back of card product information out. It will answer many of your questions about services and benefits covered through medical and additional programs offered by phc.
Member handbook care1st health plan arizona and onecare. Member handbook to help provide you with answers to all of your questions about your available health care services, see your medical member handbook. Download the medical member handbook it lists what is covered, how to get services, your rights as a member. We respect your privacy and will protect the medical information we. Download the 2020 medical provider and pharmacy directory use the provider and pharmacy directory to find. Iehp medical member services 800 4404347 800 7184347 tty iehp dualchoice member services 877 2734347 800 7184347 tty iehp 24hour nurse advice line for iehp members only. Please call our member services number or see your member handbook for more information, including the costsharing that. Download the 2018 medical member handbook it lists what is covered, how to get services, your rights as a member, your responsibilities, and much more. Be suspicious of anyone who offers you a free medical screening in exchange for your medical care1st card number if it sounds too good to be true, it probably is. Benefits andor copays may change on january 1 of each year.
To learn more about denticals coverage please visit their website or call them at 800 3226384 tty. Care health plan member services department tollfree 18888399909 as a l. For a full list of medical plans, go to the medical managed care medical plan directory for a full list of dental plans, go to the medical managed care dental plan directory. Guaranteed availability of coverage all health insurance plans except most sold before march 10, 2010 cover. Health net medi cal member handbook pdf need more help. Blue shield of california promise health plan is a managed care organization, wholly owned by blue shield of california, offering medi cal, cal mediconnect, medicare advantage hmo, and dual eligible special needs plans dsnp. Using this manual this provider manual is designed for anthem. Hpsms medical program received accreditation from the national committee for quality assurance ncqa on january 17, 2020. You can request a printed copy of your member handbook in any of the. Care1st and access dental planpremier access are teaming up to provide you with timely and appropriate access to dental services are no additional cost to you. Find out if medicare covers your test, service, or item 25.
Also known as your evidence of coverage, this document is available for you to download in the following languages at any time. That is why we offer high quality health care through health net medical. It will answer many of your questions about services and benefits covered through medical and additional programs. Cal mediconnect plan member guidebook for your dental benefits. On may 6, 2016, the centers for medicare and medicaid services published the. Confidential information may not be accessed or used without authorization. Please call member services if you have questions about anything in this handbook. Services dhcs to provide medi cal dental managed care dmc plans with clarification and guidance regarding the application of new federal and existing state regulations for the member handbook and evidence of coverage eoc requirements. Anthem blue cross has a longstanding history of providing medi cal services to californians. Compare medical plans and dental plans medical managed. In fact, anthem blue cross was one of the first medi cal managed care organizations mcos.
Medi cal pays your medicare deductibles and up to 20% cost sharing, when applicable. Health net cal mediconnect members, except in emergency situations. For free interpreter, linguistic and cultural services and help available 24 hours a day, 7 days a week, or to get this handbook in a different language, call member services monday through friday, 8 a. Blue shield promise medical members blue shield of california. American indian members may choose from american indian health program or an ahcccs health plan. If you have questions regarding a members eligibility, benefits or claims status information, we encourage you to use one of our self. Blue shields proposed acquisition of care1st faces tough. This is a state of california computer system that is for official use by authorized users and is subject to being monitored andor restricted at any time. You may view this member handbook before enrollment in the medical program. This manual provides information about how to work with mhc and will describe how we will work together as you care for our members health care needs.
This notice will tell you about how we may use and. Wellcare will be performing maintenance on saturday, may 16 from 6 pm edt to 6am edt on sunday, may 17. We have strict privacy policies to protect our members. Care, the member may choose to get services through any health plan partner listed below as long as the plan choice is available. You can get this document for free in other formats, such as large print, braille, andor audio. Medi cal is the second largest source of health care coverage in california. Care care1st health plan member, you have the right to respectful and courteous treatment. Download a printable copy of the member handbook for where you live. Carefirst administrators cfa is the only thirdparty administrator in maryland, d. This member handbook is only a summary of care1st services. Anyone with access to your records is required by law to maintain the privacy of your medical information. If you have questions or need help with your health care services, please call caloptimas customer service department at 1714 246 8500 or tollfree at 1888 587 8088, monday through friday from 8 a. When you join a cal mediconnect plan you will have only one card.
Medi cal handbook page 23 covered california overview affordable coverage and financial support individuals and families with low to moderate income may qualify for federal financial assistance. Tell your pcp or other care1st providers about any changes in your health or medical condition. All other medical members have received a bic with a 14character id. If you would like to learn exact terms and conditions of coverage, you may request a copy. You are responsible for treating your doctor and all providers and staff with. The online medical policy reference manual contains approved medical policies and operating procedures for all products offered by carefirst. Providers should always refer to the medi cal provider manualsbulletins for the most current inf. Anthem blue cross cal mediconnect plan medicaremedicaid plan 12900 park plaza drive, suite 150 mailstop 6150 cerritos, ca 90703 nondiscrimination policy.
Phc member handbook welcome call member services at 800 8634155 tty 800 7352929. Serving maryland, the district of columbia and portions of virginia, carefirst bluecross blueshield is the shared business name of carefirst of maryland, inc. Starting october 1, 2016, care1st covers dental services, including dentures, for ddd members who are 21 years of age and older. As a care1st cal mediconnect plan member, you can receive additional dental benefits, known as supplements. This member guidebook has information on your dental benefit plan. For more information contact the plan or read the member handbook. If you would like an extra copy of the member handbook at no cost to you, call member services at 18776580305 for tty, contact california relay by dialing 711 and provide the member services number. Language support resources 247 afterhours interpreting services.
The blue shield promise medical member handbook, also known as your evidence of coverage eoc, gives you details about your health care and prescription drug coverage. You can get this member handbook and other plan materials for free in other languages. Anthem blue cross care1st health plan kaiser permanente l. Department of health care services member handboo may 2019 2. Blue shield of california promise health plan is a health plan that contracts with both medicare and medical to provide benefits of both programs to enrollees. Dental benefits are available to medical members who qualify through. For a full list of medical plans, go to the medi cal managed care medical plan directory. It is also called your combined evidence of coverage and disclosure form or your eoc. This service is available at no cost to members and providers. We respect your privacy and will protect the medical information we receive about you. Care1st is a health plan providing support and services to meet the health care needs of eligible members enrolled in kidscare, ahcccs, and ddd. Your medi cal card is your card for medi cal benefits, including transportation and long term services and supports, which include inhome supportive services and nursing home care. This page contains links and publication dates for the medi cal provider training workbooks. All plans offer the same standard benefits plus extra benefits.
To speak to a nurse 24 hours a day 7 days per week, call the nurse advice line at 18007463163. Medical member handbook benefit year 20102011 care1st health plan member services department tollfree 18006052556 l. It also explains your rights and responsibilities as a member of mcp. This plan includes additional medicare prescription drug partd coverage. Comprehensive medical and dental plan cmdp or members enrolled in the.
Medical member handbook benefit year 201220 care1st health plan member services department tollfree 18006052556 l. Page 9 of 85 welcome to partnership healthplan of california. We are committed to providing health care that is medically excellent, ethicallydriven, and delivered in a patient. Preventing heath care fraud members care1st health plan.
814 1313 45 506 250 1118 2 8 1163 232 1292 1513 1408 816 67 88 494 1168 57 888 1004 1114 352 627 1243 26 1304 562 864 919 1264 809 879