Common use of Beneficiary handbook Clause in Contracts

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state and how transportation is provided. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, or network provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 of this Agreement. ix. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xi. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, in paper or electronic form, that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information.; and 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- state-approved description (WIC 14029.91(e)(4))description. Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights.; 2. The requirements and timeframes for filing a grievance or appeal.; 3. The availability of assistance in the filing process.; 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, appeal which is adverse to the beneficiary.; 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary.; x. xi. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding:; 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xixii. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries.; and xiixiii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address.; ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email.; iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost.; or iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information.; and 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- state-approved description (WIC 14029.91(e)(4))description. Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights.; 2. The requirements and timeframes for filing a grievance or appeal.; 3. The availability of assistance in the filing process.; 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, appeal which is adverse to the beneficiary.; 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary.; x. xi. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding:; 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xixii. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries.; and xiixiii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address.; ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email.; iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost.; or iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. xi. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xixii. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xiixiii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state and how transportation is provided. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, 438.100 and outlined in Article II.D.1 of this Agreement. ix. Grievance, appeal, and fair state hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state- developed or state-developed or state- approved description (WIC W&I Code section 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure include information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xi. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xii. Information on how to report suspected fraud fraud, waste or abuse. xiii. Any other content required by the State. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure include information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. xi. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specifically include specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xixii. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xiixiii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information.; and 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4))description. Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights.; 2. The requirements and timeframes for filing a grievance or appeal.; 3. The availability of assistance in the filing process.; 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, appeal which is adverse to the beneficiary.; 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary.; x. xi. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding:; 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xixii. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries.; and xiixiii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address.; ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email.; iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost.; or iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state and how transportation is provided. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure include information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specifically include specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xi. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractorContractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, beneficiary in paper or electronic form, form that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure give each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.

Beneficiary handbook. a. The Contractor shall utilize, and require its subcontractor and network subcontracted providers to utilize, the state developed model beneficiary handbook. b. The Contractor shall ensure provide each beneficiary is provided a beneficiary handbook, within a reasonable time after receiving notice of the beneficiary’s enrollment, which serves as the summary of benefits and coverage described in 45 CFR § 147.200(a). c. The content of the beneficiary handbook shall include information that enables the beneficiary to understand how to effectively use the managed care program. This information shall include at a minimum: i. Benefits provided by the Contractor, including Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefits. ii. How and where to access any benefits, including EPSDT benefits, provided by the state state, including any cost sharing, and how transportation is provided. 1. In the case of a counseling or referral service that a subcontracted provider does not cover because of moral or religious objections, the Contractor shall inform the beneficiaries that the service is not covered. 2. The Contractor shall inform beneficiaries how they can access the services that are not covered by the subcontracted provider because of moral or religious objections. iii. The amount, duration, and scope of benefits available under the Agreement in sufficient detail to ensure that beneficiaries understand the benefits to which they are entitled. iv. Procedures for obtaining benefits, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Contractor, the subcontractor, Contractor or network a subcontracted provider. v. The extent to which, and how, after-hours care is provided. vi. Any restrictions on the beneficiary’s freedom of choice among network providers. vii. The extent to which, and how, beneficiaries may obtain benefits from out-of-network providers. viii. Cost sharing, if any, is imposed under the State Plan. ix. Beneficiary rights and responsibilities, including: 1. The beneficiary’s right to receive beneficiary and plan information. 2. The elements specified in 42 CFR §438.100, and outlined in Article II.D.1 II. ,D. ,1 of this Agreement. ix. x. Grievance, appeal, and fair hearing procedures and timeframes, consistent with Article II.G of this Agreement, in a state-developed or state- approved description (WIC 14029.91(e)(4)). Such information shall include: 1. The right to file grievances and appeals. a. The Contractor shall ensure include information is included on filing a Discrimination Grievance with the Contractor, the subcontractor, the DHCS Office of Civil Rights and the U.S. Health and Human Services Office for Civil Rights, and shall specifically include information stating that the Contractor complies with all State and Federal civil rights laws. If a beneficiary believes they have been unlawfully discriminated against, they have the right to file a Discrimination Grievance with the Contractor, the subcontractor, the Department’s Office of Civil Rights, and the United States Department of Health and Human Services, Office for Civil Rights. 2. The requirements and timeframes for filing a grievance or appeal. 3. The availability of assistance in the filing process. 4. The right to request a state fair hearing after the Contractor’s subcontractor Contractor has made a determination on a beneficiary’s appeal, which is adverse to the beneficiary. 5. The fact that, when requested by the beneficiary, benefits that the subcontractor Contractor seeks to reduce or terminate will continue if the beneficiary files an appeal or a request for state fair hearing within the timeframes specified for filing, and that the beneficiary may, consistent with state policy, be required to pay the cost of services furnished while the appeal or state fair hearing is pending if the final decision is adverse to the beneficiary. x. How to access auxiliary aids and services, including additional information in alternative formats or languages. The Contractor shall ensure the specific information is included regarding: 1. The provision of cost free aids and services to individuals with disabilities (qualified sign language interpreters, written information in other formats). 2. The provision of cost free language services to individuals whose primary language is not English (qualified interpreters, information written in other languages). xi. The toll-free telephone number for member services, medical management, and any other unit providing services directly to beneficiaries. xii. Information on how to report suspected fraud or abuse. d. The beneficiary handbook will be considered to be provided if the Contractor ensures the subcontractor: i. Mails a printed copy of the information to the beneficiary’s mailing address. ii. Provides the information by email after obtaining the beneficiary’s agreement to receive the information by email. iii. Posts the information on the Contractor’s website and advises the beneficiary, in paper or electronic form, that the information is available on the Internet and includes the applicable Internet address, provided that beneficiaries with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost. iv. Provides the information by any other method that can reasonably be expected to result in the beneficiary receiving that information. e. The Contractor shall ensure each beneficiary is given notice of any significant change in the information specified above, at least 30 days before the intended effective date of the change.