Information Materials Requirements. The Contractor shall notify all Members of their right to request and obtain the information listed herein at least once a year and within a reasonable time after the Contractor receives from the Department notice of the Member's enrollment. Any change in the information listed herein shall be communicated at least thirty (30) days before the intended effective date of the change.
A. Names, locations, telephone numbers of, and non-English languages spoken by, Providers in the Contractor’s network, including identification of Providers that are not accepting new patients. This includes, at a minimum, information on primary care physicians, specialists, and hospitals.
B. Any restrictions on the Member's freedom of choice among network Providers.
C. Any changes in covered services by the Contractor due to moral or religious objections and how to obtain the service.
D. Member rights and protections, as specified in 42 CFR §438.100.
E. Information on the right to file grievances and appeals and procedures as provided in 42 CFR §§438.400 through 438.424 and 907 KAR 17:010, including: requirements and timeframes for filing a grievance or appeal; availability of assistance in the filing process; toll-free numbers that the Member can use to file a grievance or an appeal by phone; that when requested benefits can continue during the grievance or appeal; and that the Member may be required to pay the cost of services furnished while the appeal is pending, if the final decision is adverse to the Member.
F. Information on a State fair hearing including the right to hearing; method for obtaining a hearing; and rules that govern representation at the hearing.
G. The amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Members understand the benefits to which they are entitled.
H. Procedures for obtaining benefits, including authorization requirements.
I. The extent to which, and how, Members may obtain benefits, including family planning services, from out-of-network providers.
J. The extent to which, and how, after-hours and emergency coverage are provided, including:
(1) What constitutes emergency medical condition, emergency services, and post-stabilization services, with reference to the definitions in 42 CFR §438.114(a) and 907 KAR 3:130.
(2) The fact that prior authorization is not required for emergency services.
(3) The process and procedures for obtaining emergency services, including use of the 911-telephone s...
Information Materials Requirements. The Contractor shall notify all Enrollees of their right to request and obtain the information listed herein at least once a year and within a reasonable time after the Contractor receives from the Department notice of the Enrollee's Enrollment. Any change in the information listed herein shall be communicated at least thirty (30) Days before the intended effective date of the change.
A. Names, locations, telephone numbers of, and non-English languages spoken by, Providers in the Contractor’s Network, including identification of Providers that are not accepting new patients. This includes, at a minimum, information on PCPs, specialists, and hospitals;
B. Any restrictions on the Enrollee's freedom of choice among network Providers;
C. Any changes in Covered Services by the Contractor due to moral or religious objections and how to obtain the service;
D. Enrollee rights and protections, as specified in 42 C.F.R. §438.100:
E. Information on the right to file grievances and Appeals and procedures as provided in 42 C.F.R. §§438.400 through 438.424 and 907 KAR 17:010, including: requirements and timeframes for filing a grievance or Appeal; availability of assistance in the filing process; toll- free numbers that the Enrollee can use to file a grievance or an Appeal by phone; that when requested benefits can continue during the grievance or Appeal; and that the Enrollee may be required to pay the cost of services furnished while the Appeal is pending, if the final decision is adverse to the Enrollee;
F. Information on a State fair hearing including the right to hearing; method for obtaining a hearing; and rules that govern representation at the hearing;
G. The amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;
X. Xxxxxxxxxx for obtaining benefits, including authorization requirements;
I. The extent to which, and how, Enrollees may obtain benefits, including Family Planning Services, from Out-of-Network Providers;
J. The extent to which, and how, after-hours and emergency coverage are provided, including:
1. What constitutes Emergency Medical Condition, Emergency Services, and Post- Stabilization Services, with reference to the definitions in 42 C.F.R. §438.114(a) and 907 KAR 3:130;
2. The fact that Prior Authorization is not required for Emergency Services;
3. The process and procedures for obtaining Emergency Services, including use of the 911- tel...
Information Materials Requirements. The Contractor shall notify all Enrollees of their right to request and obtain the information listed herein at least once a year and within a reasonable time after the Contractor receives from the Department notice of the Enrollee's Enrollment. Any change in the information listed herein shall be communicated at least thirty (30) Days before the intended effective date of the change.
A. Names, locations, telephone numbers of, and non-English languages spoken by, Providers in the Contractor’s Network, including identification of Providers that are not accepting new patients. This includes, at a minimum, information on PCPs, specialists, and hospitals;
B. Any restrictions on the Enrollee's freedom of choice among network Providers;
C. Any changes in Covered Services by the Contractor due to moral or religious objections and how to obtain the service;
D. Enrollee rights and protections, as specified in 42 C.F.R. §438.100: E. Information on the right to file grievances and Appeals and procedures as provided in 42 C.F.R. §§438.400 through 438.424 and 907 KAR 17:010, including: requirements and timeframes for filing a grievance or Appeal; availability of assistance in the filing process; toll- free numbers that the Enrollee can use to file a grievance or an Appeal by phone; that when requested benefits can continue during the grievance or Appeal; and that the Enrollee may be required to pay the cost of services furnished while the Appeal is pending, if the final decision is adverse to the Enrollee;
