PHP Care Complete FIDA-IDD Plan: Summary of Benefits

Transcription

1 H9869_2016_PHP_FIDA-IDD_SummaryOfBenefits PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits This is a summary f health services cvered by PHP Care Cmplete FIDA-IDD Plan fr This is nly a summary. Please read the Participant Handbk fr the full list f benefits. Partners Health Plan is a managed care plan that cntracts with Medicare, the New Yrk State Department f Health (Medicaid), and the Office fr Peple With Develpmental Disabilities t prvide benefits t Participants thrugh the Fully Integrated Duals Advantage fr individuals with Intellectual and Develpmental Disabilities (FIDA-IDD) Demnstratin. It is fr peple with bth Medicare and Medicaid and wh meet ther eligibility requirements fr the FIDA-IDD Demnstratin. Under PHP Care Cmplete FIDA-IDD Plan yu can get yur Medicare and Medicaid services in ne managed care plan called a FIDA-IDD Plan. A PHP Care Cmplete FIDA-IDD Care Manager will help manage yur 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 Participant Handbk. Limitatins and restrictins may apply. Fr mre infrmatin, call PHP Care Cmplete FIDA-IDD Plan Participant Services r read the PHP Care Cmplete FIDA-IDD Plan Participant Handbk. The List f Cvered Drugs and/r pharmacy and prvider netwrks may change thrughut the year. We will send yu a ntice befre we make a change that affects yu. Benefits may change n January 1 f each year. Yu can get this infrmatin fr free in ther frmats, such as large print, braille, r audi. Call and 711 fr TTY/TDD users during 8 AM t 8 PM, seven days a week. The call is free. Yu can get this infrmatin fr free in ther languages. Call , and 711 fr TTY users, during the hurs f 8:00 am t 8:00 pm, 7 days a week. The call is free. Puede btener esta infrmación gratis en Españl. Llame a Servicis del Participante al durante las hras de 8:00 am a 8:00pm, 7 días de la semana. Usuaris de TTY llamar al 711. La llamada es gratuita. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 1

2 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Lei pu ttenere questi infrmazini in Italian gratuitamente. Chiama il Servizi Partecipanti a durante il perid da 8AM a 8PM, 7 girni alla settimana. TTY utilizzatri dvressi chiamare 711. La chiamata è gratis. Ou ka jwenn enfòmasyn sa a pu gratis nan kreyòl ayisyen. Rele sèvis patisipan nan les heures de 8:00 je pu 8:00 pm, 7 ju nan semenn nan. Utilisateurs TTY ta dwe rele 711. Apèl gratis. Вы можете получить эту информацию бесплатно на русском языке. Звоните в Отдел обслуживания участников плана по телефону с 8:00 утра до 8:00 вечера, 7 дней в неделю. Пользователи TTY звоните по телефону 711. Звонок бесплатный. 您可免費獲得到以上的中文資訊, 請致電參與者服務電話 , 辦公時間為上午 8 時到下午 8 時, 每週 7 天 聽力語言殘障服務專線 (TTY) 用戶請撥打 711 該電話為免付費通話 한국어로된정보를무료로얻을수있습니다. 주 7 일오전 8 시에서오후 8 시사이에 번 (TTY 사용자는 711 번 ) 으로문의해 주십시오. 통화는무료입니다. The State f New Yrk has created a participant mbudsman prgram called the Independent Cnsumer Advcacy Netwrk (ICAN) t prvide Participants free, cnfidential assistance n any services ffered by PHP Care Cmplete FIDA-IDD Plan. ICAN may be reached tll-free at (TTY users, call 711) r nline at icannys.rg. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 2

3 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits The fllwing chart lists frequently asked questins. Frequently Asked Questins (FAQ) What is a Fully Integrated Duals Advantage fr individuals with Intellectual and Develpmental Disabilities (FIDA-IDD) Plan What is a PHP Care Cmplete FIDA- IDD Care Manager and Interdisciplinary Team (IDT) Answers A Fully Integrated Duals Advantage fr individuals with Intellectual and Develpmental Disabilities (FIDA-IDD) Plan is an rganizatin made up f dctrs, hspitals, pharmacies, prviders f lng-term services, and ther prviders. It als has Care Managers and Interdisciplinary Teams t help yu plan and manage all yur prviders and services. They all wrk tgether t prvide the care yu need. PHP Care Cmplete is a FIDA-IDD Plan that prvides benefits f Medicaid and Medicare t Participants in the FIDA-IDD Demnstratin. A PHP Care Cmplete FIDA-IDD Care Manager is ne main persn that yu may cntact. This persn helps manage all yur prviders and services and makes sure yu get what yu need. This persn is part f yur Interdisciplinary Team (IDT), which als includes: Yu and yur caregiver/guardian r designee(s); Yur primary prviders f Develpmental Disability services, wh have knwledge f yur desired utcmes and service needs; Additinal individuals, including: Yur Primary Care Prvider (PCP) r a designee frm yur PCP s ffice (r practice) wh has clinical experience and knwledge f yur needs; Yur Behaviral Health (BH) Prfessinal, if yu have ne, r a designee frm yur BH Prfessinal s ffice (r practice) wh has clinical experience and knwledge f yur needs; Yur hme care aide(s), r a designee with clinical experience frm the hme care agency wh has knwledge f yur needs, if yu are receiving hme care and apprve the hme care aide/designee s participatin n the IDT; A clinical representative frm yur Intermediate Care Facility (ICF), if receiving ICF care; and Other prviders, either as requested by yu r yur caregiver/guardian r designee, r as recmmended by the IDT members as necessary fr adequate care planning and apprved by yu r yur designee. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 3

4 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Frequently Asked Questins (FAQ) What are lng-term services and supprts Can I direct my wn care r hire my wn aides Will I get the same Medicare and Medicaid benefits in PHP Care Cmplete FIDA-IDD Plan that I get nw Answers 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 facility r hspital. Yu have the right t chse t direct yur wn care by selecting Cnsumer Directed Persnal Assistance Services (CDPAS). Thrugh CDPAS, yu can hire yur wn aides and make ther decisins abut hw t receive services. Yu will get yur cvered Medicare and Medicaid benefits directly frm PHP Care Cmplete FIDA-IDD Plan. Yu will wrk with a team f prviders 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 PHP Care Cmplete FIDA-IDD Plan, but yu will get Hspice Services the same way yu d nw, utside f the plan. When yu enrll in PHP Care Cmplete FIDA-IDD Plan, yu and yur Interdisciplinary Team (IDT) will wrk tgether t develp a Life Plan (LP) t address yur health and supprt needs. When yu first enrll in PHP Care Cmplete FIDA-IDD Plan, yu can keep seeing yur dctrs and getting yur current services fr 90 days, r until yur LP is cmplete, whichever is later. Hwever, yu can chse t begin receiving services in accrdance with yur apprved Life Plan prir t 90 days. When yu jin ur plan, if yu are taking any Medicare Part D prescriptin drugs that PHP Care Cmplete FIDA-IDD Plan des nt nrmally cver, yu can get a temprary supply. We will help yu get anther drug r get an exceptin fr PHP Care Cmplete FIDA-IDD Plan t cver yur drug, if medically necessary. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 4

5 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Frequently Asked Questins (FAQ) Can I g t the same dctrs I see nw What happens if I need a service but n ne in PHP Care Cmplete s netwrk can prvide it Where is PHP Care Cmplete FIDA- IDD Plan available D I pay a mnthly amunt (als called a premium) under PHP Care Cmplete FIDA-IDD Plan Answers Often that is the case. If yur prviders (including dctrs, therapists, and pharmacies) wrk with PHP Care Cmplete FIDA-IDD Plan 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 PHP Care Cmplete FIDA-IDD Plan s netwrk, unless PHP Care Cmplete FIDA-IDD Plan r yur IDT has authrized yu t see an ut-f-netwrk prvider. If yu need urgent r emergency care r utf-area dialysis services, yu can use prviders utside f PHP Care Cmplete FIDA-IDD Plan s netwrk. T find ut if yur dctrs are in the plan s netwrk, call Participant Services r read PHP Care Cmplete FIDA-IDD Plan s Prvider and Pharmacy Directry. If PHP Care Cmplete FIDA-IDD Plan is new fr yu, yu can cntinue seeing the dctrs yu g t nw fr 90 days r until yur Life Plan is cmplete, whichever is later. Hwever, yu can chse t begin receiving services in accrdance with yur apprved Life Plan prir t 90 days. If yu currently receive behaviral health services, yur Interdisciplinary Team (IDT) will review yur current episde f care t decide if yu can cntinue the services with the same prvider yu see nw. If they r PHP Care Cmplete FIDA-IDD Plan decide yu can see the same prvider yu see nw, yu will be able t see that prvider fr 24 mnths fllwing yur enrllment in PHP Care Cmplete FIDA-IDD Plan. Mst services will be prvided by ur netwrk prviders. If yu need a service that cannt be prvided within ur netwrk, PHP Care Cmplete FIDA-IDD Plan will pay fr the cst f an utf-netwrk prvider. The service area fr this plan includes: Brnx, Kings/Brklyn, Nassau, New Yrk, Queens, Richmnd, Rckland, Sufflk and Westchester Cunties, New Yrk. Yu must live in ne f these areas t jin the plan. Yu will nt pay any mnthly premiums t PHP Care Cmplete FIDA-IDD Plan fr yur cverage. Yu als will nt have any c-payments r ther csts when yu get care frm netwrk prviders. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 5

6 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Frequently Asked Questins (FAQ) What is prir authrizatin What is a referral Answers Prir authrizatin means that yu must get apprval frm PHP Care Cmplete FIDA-IDD Plan r yur Interdisciplinary Team (IDT) befre yu can get a specific service, item, r drug r befre yu can see an ut-f-netwrk prvider. PHP Care Cmplete FIDA-IDD Plan may nt cver the service, item, r drug if yu dn t get apprval frm PHP Care Cmplete FIDA-IDD Plan r yur IDT. A small number f services require prir authrizatin by a specialist and nt by PHP Care Cmplete FIDA-IDD Plan r yur IDT. Please refer t Chapter 4 f yur Participant Handbk fr mre infrmatin. PHP Care Cmplete FIDA-IDD Plan can als prvide yu with a list f services r prcedures that require yu t get prir authrizatin frm a prvider ther than yur IDT. Sme services d nt require any prir authrizatin, such as emergency r urgently needed care, ut-f-area dialysis services, primary care prvider visits, and wmen s health specialist services. Fr the full list f services that d nt require prir authrizatin, please see Chapter 4 f yur Participant Handbk r call PHP Care Cmplete FIDA-IDD Plan. A referral means that yur Primary Care Prvider gives yu apprval t see a prvider ther than yur Primary Care Prvider. Referrals are nt necessary in PHP Care Cmplete FIDA-IDD Plan and will nt be required. Hwever, prir authrizatin rules must be fllwed. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 6

7 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Frequently Asked Questins (FAQ) Wh shuld I cntact if I have questins r need help Answers If yu have general questins r questins abut ur plan, services, service area, billing, r Participant cards, please call PHP Care Cmplete FIDA-IDD Participant Services: CALL TTY 711 Calls t this number are free. 8 AM t 8 PM, seven days a week. Participant Services als has free language interpreter services available fr peple wh d nt speak English. 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. 8 AM t 8 PM, seven days a week. If yu have questins abut yur health, please call the Nurse Advice Call line: CALL TTY 711 Calls t this number are free. 24 hurs a day, seven days a week 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. 24 hurs a day, seven days a week If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 7

8 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits 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 Yu want t see a dctr Visits t treat an injury r illness $0 Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Wellness visits, such as a physical $0 Transprtatin t a dctr s ffice $0 Specialist care $0 Care t keep yu frm getting sick, such as flu shts Welcme t Medicare preventive visit (ne time nly) Yu need medical tests Lab tests, such as bld wrk $0 $0 $0 X-rays r ther pictures, such as CAT scans Screening tests, such as tests t check fr cancer $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. $0 If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 8

9 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits 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. There may be limitatins n the types f drugs cvered. Please see PHP Care Cmplete s List f Cvered Drugs (Drug List) fr mre infrmatin. Brand name drugs $0 fr a 30-day supply. There may be limitatins n the types f drugs cvered. Please see PHP Care Cmplete s List f Cvered Drugs (Drug List) fr mre infrmatin. Yu need drugs t treat yur illness r cnditin (cntinued) Over-the-cunter drugs $0 PHP Care Cmplete FIDA-IDD Plan cvers sme OTC drugs when they are written as prescriptins by yur prvider. Please see PHP Care Cmplete s List f Cvered Drugs (Drug List) fr mre infrmatin. Yu need therapy after a strke r accident 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 Participant Handbk fr mre infrmatin n these drugs. Occupatinal, physical, r speech therapy $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Yu need emergency care Emergency rm services $0 Emergency rm services are cvered whether yu are in r utside f PHP Care Cmplete FIDA-IDD Plan s service area. N prir authrizatin is required fr these services. Ambulance services $0 If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 9

10 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Health need r prblem Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Urgent care $0 Urgent care services are cvered whether yu are in r utside f PHP Care Cmplete FIDA-IDD Plan s service area. N prir authrizatin is required fr these services. Yu need hspital care Hspital stay $0 Yu need help getting better r have special health needs Dctr r surgen care $0 Rehabilitatin services $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Medical equipment fr hme care $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Skilled nursing care $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Yu need eye care Eye exams $0 Glasses r cntact lenses $0 Yu need dental care Dental check-ups $0 Yu need hearing/auditry services Yu have a chrnic cnditin, such as diabetes r heart disease Yu have a mental health cnditin Hearing screenings $0 Hearing aids $0 Services t help manage yur disease $0 Diabetes supplies and services $0 Mental r behaviral health services $0 If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 10

11 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Health need r prblem Yu have a substance abuse prblem Yu need lng-term mental health services Yu need durable medical equipment (DME) Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Substance abuse services $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Inpatient care fr peple wh need mental health care $0 Wheelchairs $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Canes $0 Yu need help living at hme Crutches $0 Walkers $0 Oxygen $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Hme services, such as cleaning r husekeeping Persnal care assistant (Yu may be able t emply yur wn assistant. Call Participant Services fr mre infrmatin.) $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Hme health care services $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD plan may be required. Services t help yu live n yur wn $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Adult day services r ther supprt services $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. Yu need a place t live Intermediate Care Facility $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 11

12 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Health need r prblem with peple available t help yu Services yu may need Yur csts fr in-netwrk prviders Limitatins, exceptins, & benefit infrmatin (rules abut benefits) Nursing facility care $0 Prir authrizatin by yur IDT r PHP Care Cmplete FIDA-IDD Plan may be required. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 12

13 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Waiver services that PHP Care Cmplete FIDA-IDD Plan cvers In additin, individuals enrlled in the Office fr Peple With Develpmental Disabilities Hme and Cmmunity Based Services 1915(c) waiver prgram can receive the services listed belw. Call Participant Services r read the Participant Handbk t find ut abut ther cvered services. Other services cvered by PHP Care Cmplete FIDA-IDD Plan (This is nt a cmplete list. Talk t yur Care Manager abut ther available services t meet yur needs.) Cmmunity Habilitatin $0 Day Habilitatin - Grup $0 Day Treatment $0 Pathway t Emplyment $0 Prevcatinal Services $0 Respite $0 Self-directed Services $0 Supervised / Supprtive IRAs $0 Supprted Emplyment (SEMP) $0 Yur csts fr in-netwrk prviders Benefits cvered utside f PHP Care Cmplete FIDA-IDD Plan This is nt a cmplete list. Call Participant Services t find ut abut ther services nt cvered by PHP Care Cmplete FIDA-IDD Plan but available thrugh Medicare r Medicaid. Other services cvered by Medicare r Medicaid Yur csts Hspice services $0 If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 13

14 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Services that PHP Care Cmplete FIDA-IDD Plan, Medicare, and Medicaid d nt cver This is nt a cmplete list. Call Participant Services t find ut abut ther excluded services. Services nt cvered by PHP Care Cmplete FIDA-IDD Plan, Medicare, r Medicaid Acupuncture Assisted Living Plastic r Recnstructive Surgery If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 14

15 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits Yur rights as a Participant f the plan As a Participant f PHP Care Cmplete FIDA-IDD Plan, yu have certain rights. Yu can exercise these rights withut being punished. Yu can als use these rights withut lsing yur services frm PHP Care Cmplete FIDA-IDD Plan. We will tell yu abut yur rights at least nce a year. Fr mre infrmatin n yur rights, please read the Participant Handbk. This is nt a cmplete list f all yur rights. 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 Request infrmatin in ther frmats (e.g., large print, braille, audi) Be free frm any frm f restraint r seclusin Nt be billed by netwrk prviders Have yur questins and cncerns answered cmpletely and curteusly Freely apply yur rights withut any negative effect n the way PHP Care Cmplete FIDA-IDD Plan r yur prvider treats yu 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 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 Participate in Interdisciplinary Team meetings abut yur care Get yur cvered services and drugs quickly Knw abut all treatment ptins, n matter what they cst r whether they are cvered Refuse treatment, even if yur dctr advises against it Stp taking medicine Ask fr a secnd pinin. PHP Care Cmplete FIDA-IDD Plan will pay fr the cst f yur secnd pinin visit Create and apply an advance directive, such as a living will r health care prxy 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 If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 15

16 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits 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 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 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 See an ut f netwrk urgent r emergency care prvider, when necessary Have yur persnal health infrmatin kept private Direct yur wn care r hire yur wn aides thrugh Cnsumer-Directed Persnal Assistance Services 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 Get a detailed reasn fr why services were denied Fr mre infrmatin abut yur rights, yu can read the PHP Care Cmplete FIDA-IDD Participant Handbk. If yu have questins, yu can als call PHP Care Cmplete FIDA-IDD Participant Services. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 16

17 PHP Care Cmplete FIDA-IDD Plan: Summary f Benefits If yu have a cmplaint r think we shuld cver smething we denied If yu have a cmplaint r think PHP Care Cmplete FIDA-IDD Plan shuld cver smething we denied, call PHP Care Cmplete FIDA- IDD Plan at Yu may be able t appeal ur decisin. Fr questins abut grievances (cmplaints) and appeals, yu can read Chapter 9 f the PHP Care Cmplete FIDA-IDD Participant Handbk. Yu can als call PHP Care Cmplete FIDA-IDD Participant Services at the number at the bttm f this page. Additinally, yu can get help frm the Independent Cnsumer Advcacy Netwrk (ICAN). ICAN can give yu free, cnfidential assistance n any services ffered by PHP Care Cmplete FIDA-IDD Plan, including any prblems getting quality care. ICAN may be reached at (TTY users, call 711) r nline at icannys.rg. Cntact PHP Care Cmplete FIDA-IDD Plan s Participant Services if yu have a cmplaint, grievance r an appeal. 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 PHP Care Cmplete FIDA-IDD Participant 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. If yu have questins, please call PHP Care Cmplete FIDA-IDD Plan at , 8 AM t 8 PM, seven days a week. TTY users, call 711. The call is free. Fr mre infrmatin, visit 17