Member Handbook. The Contractor shall develop a member handbook for its members. The Contractor’s member handbook shall be submitted annually for OMPP’s review. The member handbook shall include the Contractor’s contact information and Internet website address and describe the terms and nature of services offered by the Contractor, including the following information required under 42 CFR 438.10(f), which enumerates certain required information. The member handbook may be offered in an electronic format as long as the Contractor complies with 42 CFR 438.10(c)(6). The Hoosier Healthwise MCE Policies and Procedures Manual outlines the member handbook requirements. The Hoosier Healthwise member handbook shall include the following: Contractor’s contact information (address, telephone number, TDD number, website address); The amount, duration and scope of services and benefits available under the Contract in sufficient details to ensure that participants are informed of the services to which they are entitled, including, but not limited to the differences between the benefit options; The procedures for obtaining benefits, including authorization requirements; Contractor’s office hours and days, including the availability of a 24-hour Nurse Call Line; Any restrictions on the member’s freedom of choice among network providers, as well as the extent to which members may obtain benefits, including family planning services, from out-of-network providers; The extent to which, and how, after-hours and emergency coverage are provided, as well as other information required under 42 CFR 438.10(f), such as what constitutes an emergency; The post-stabilization care services rules set forth in 42 CFR 422.113(c); The extent to which, and how, urgent care services are provided; Applicable policy on referrals for specialty care and other benefits not provided by the member’s PMP, if any; Information about the availability of pharmacy services and how to access pharmacy services; Member rights and protections, as enumerated in 42 CFR 438.100, which relates to enrollee rights. See Section 4.8 for further detail regarding member rights and protections; Responsibilities of members; Special benefit provisions (for example, co-payments, deductibles, limits or rejections of claims) that may apply to services obtained outside the Contractor’s network; Procedures for obtaining out-of-network services; Standards and expectations to receive preventive health services; Pol...
Member Handbook. If an individual is re-enrolled within sixty (60) days of Disenrollment, the Contractor is only required to send the Member a new identification card. However, the complete Member Information Packet must be supplied upon Member request.
Member Handbook. (A) After execution of the Contract, and upon request of the Department, the Contractor shall submit its member handbook to the Department for review and approval. The Department shall notify the Contractor in writing of its approval or disapproval within thirty working days after receiving the member handbook. If the Department does not respond within thirty days, the Contractor may deem its member handbook approved by the Department.
(B) At minimum, the member handbook shall explain in clear terms the following information:
(1) The amount, duration, and scope of benefits provided by the Contractor described in sufficient detail to ensure that Enrollees understand scope of service and the benefits to which they are entitled;
(2) Contractor’s procedures for obtaining benefits, including service authorization requirements;
(3) The extent to which, and how, enrollees may obtain benefits from Non-Participating Providers;
(4) The extent to which, and how, after-hours emergency coverage is provided including:
(i) what constitutes an Emergency Medical Condition, Emergency Services, and Post-Stabilization Care Services with reference to the definitions in 42 CFR 438.114(a);
(ii) the fact that prior authorization is not required for Emergency Services;
(iii) the process and procedures for obtaining Emergency Services including use of the 911 telephone system or its local equivalent;
(iv) the location of any emergency settings and other locations at which Providers and hospitals furnish Emergency Services and Post-Stabilization Care Services covered under Contract; and
(v) the fact that the Enrollee has the right to use any hospital or other setting for emergency care.
(5) The Post-Stabilization Care Services rules set forth at 42 CFR 422.113(c);
(6) Contractor’s policy on referrals for specialty care and for other benefits not furnished by the Enrollee’s Primary Care Provider;
(7) Description of Enrollee cost-sharing requirements, where applicable;
(8) How and where to access any benefits that are available under the State plan but are not covered under the Contract, including any cost sharing, and how transportation is provided;
(9) A statement that the Contractor does not discriminate against any Enrollee on the basis of race, color, national origin, disability, sex, religion, or age in admission, treatment or participation in its programs, services, and activities;
(10) Information on the availability of oral interpretation, including the fact that it is availa...
Member Handbook. HHSC must approve the Member Handbook, and any substantive revisions, prior to publication and distribution. As described in Section 7, “Transition Phase Requirements,” the MCO must develop and submit to HHSC the draft Member Handbook for approval during the Readiness Review and must submit a final Member Handbook incorporating changes required by HHSC prior to the Operational Start Date. The Member Handbook for each applicable MCO Program must, at a minimum, meet the Member materials requirements specified by Section 8.1.5.1 and must include critical elements in Uniform Managed Care Manual Chapter 3, “Critical Elements.” CHIP MCOs must issue Member Handbooks to both CHIP Perinates and CHIP Perinate Newborns. The Member Handbook for CHIP Perinate Newborns may be the same as that used for CHIP. The MCO must produce a revised Member Handbook, or an insert informing Members of changes to Covered Services, upon HHSC notification and at least 30 days prior to the effective date of such change in Covered Services. In addition to modifying the Member Materials for new Members, the MCO must notify all existing Members of the Covered Services change during the timeframe specified in this subsection.
Member Handbook. HHSC must approve the Member Handbook, and any substantive revisions, prior to publication and distribution. As described in Attachment B-1, Section 7, the HMO must develop and submit to HHSC the draft Member Handbook for approval during the Readiness Review and must submit a final Member Handbook incorporating changes required by HHSC prior to the Operational Start Date. The Member Handbook for each applicable HMO Program must, at a minimum, meet the Member materials requirements specified by Section 8.1.5.1 above and must include critical elements in the Uniform Managed Care Manual. CHIP Perinatal HMOs must issue Member Handbooks to both CHIP Perinates and CHIP Perinate Newborns. The Member Handbook for CHIP Perinate Newborns may be the same as that used for CHIP. The HMO must produce a revised Member Handbook, or an insert informing Members of changes to Covered Services upon HHSC notification and at least 30 days prior to the effective date of such change in Covered Services. In addition to modifying the Member materials for new Members, the HMO must notify all existing Members of the Covered Services change during the time frame specified in this subsection.
Member Handbook. The PH-MCO must provide a Member handbook, or other written materials, with information on Member rights and protections and how to access services, in the appropriate language or alternate format to Members within five (5) Business Days of a Member’s effective date of Enrollment. The PH-MCO may provide the Member handbook in formats other than hard copy. If this option is exercised, the PH-MCO must inform Members what formats are available and how to access each format. The PH-MCO must maintain documentation verifying that the Member handbook is reviewed for accuracy at least once a year, and that all necessary modifications have been made. The PH-MCO must notify all Members on an annual basis of any changes made, and the formats and methods available to access the handbook. Upon request, the PH-MCO must provide a hard copy version of the Member handbook to the Member. The PH-MCO is required to provide adult enrollees with written information on advance directives policies and include description of applicable state law. The PH-MCO is required to reflect changes in state law in its written advance directives information as soon as possible, but no later than 90 days after the effective date of the change.
Member Handbook. The Contractor shall develop a member handbook for its members. The Contractor’s member handbook shall be submitted annually for OMPP’s review. The member handbook shall include the Contractor’s contact information and Internet website address and describe the terms and nature of services offered by the Contractor, including the following information required under 42 CFR 438.10(f), which enumerates certain required information. The member handbook may be offered in an electronic format as long as the Contractor complies with 42 CFR 438.10(c)(6). The Hoosier Healthwise MCE Policies and Procedures Manual outlines the member handbook requirements. The Hoosier Healthwise member handbook shall include the following: Contractor’s contact information (address, telephone number, TDD number, website address); The amount, duration and scope of services and benefits available under the Contract in sufficient details to ensure that participants are informed of the services to which they are entitled, including, but not limited to the differences between the benefit options; The procedures for obtaining benefits, including authorization requirements;
EXHIBIT 1. E HOOSIER HEALTHWISE SCOPE OF WORK EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK
Member Handbook. The PH-MCO must provide a Member handbook, or other written materials, with information on Member rights and protections and how to access services, in the appropriate language or alternate format to Members within five (5) Business Days of a Member’s effective date of Enrollment. The PH-MCO may provide the Member handbook in formats other than hard copy. If this option is exercised, the PH-MCO must inform Members what formats are available and how to access each format. The PH-MCO must maintain documentation verifying that the Member handbook is reviewed for accuracy at least once a year, and that all necessary modifications have been made. All Members must be notified on an annual basis of any changes made, and the formats and methods available to access the handbook. Upon request, the PH-MCO must provide a hard copy version of the Member handbook to the Member.
Member Handbook. Plan shall provide Employer Group with copies of a Member Handbook and Provider Directory and Supplemental Benefits brochures, if applicable, setting forth the Benefits to which the Members are entitled hereunder, and with copies of all amendments to such documents. Employer Group shall be responsible for distributing and shall distribute such forms, and all amendments thereto, to Enrolled Employees.
Member Handbook. The Contractor shall develop a member handbook for its members and disseminate it as required under 42 CFR 438.10(g)(3)(i)-(iv). The Contractor is required to provide members notice of any significant change, as defined by the State, in the information specified in the member handbook at least thirty (30) days before the intended effective date of the change per 42 CFR 438.10
