Member Helpline Clause Samples

The Member Helpline clause establishes a dedicated support channel for members to seek assistance or information regarding their membership or related services. Typically, this clause outlines the availability of the helpline, such as operating hours, contact methods (like phone or email), and the types of inquiries it can address, such as account issues or service guidance. Its core function is to ensure members have reliable access to help, thereby improving user experience and resolving issues efficiently.
Member Helpline. The HMO must furnish a toll-free phone line which members may call 24 hours a day, 7 days a week. An answering service or other similar mechanism, which allows callers to obtain information from a live person, may be used for after-hours and weekend coverage. 3.7.2.1 HMO must provide coverage for the following services at least during HMO's regular business hours (a minimum of 9 hours a day, between 8 a.m. and 6 p.m.), [Deletion] Monday through Friday: 1. Member ID information 2. To change PCP 3. Benefit explanations 4. PCP verification 5. Access issues (including referrals to specialists) 6. Problems Accessing PCP 7. Member eligibility 8. Complaints 9. Service area issues (including when member is temporarily out-of-service area)
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Member Helpline. The HMO must furnish a toll free phone line which members may call 24 hours a day, 7 days a week. An answering service or other similar mechanism, which allows callers to obtain information from a live person, may be used for after-hours and weekend coverage. 3.7.2.1 HMO must provide coverage for the following services at least during HMO's regular business hours (a minimum of 9 hours a days between 8 a.m. and 6 p.m.) Monday through Friday: 1. Member ID information 2. PCP Change 3. Benefit understanding 4. PCP verification 5. Access issues (including referrals to specialists) 6. Unavailability of PCP 7. Member eligibility 8. Complaints 9. Service area issues (including when member is temporarily out-of-service area) 10. Other services covered by member services. 3.7.2.2 HMO must provide TDH with policies and procedures indicating how the HMO will meet the needs of members who are unable to contact HMO during regular business hours.
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Member Helpline. The HMO must furnish a toll-free phone line that members may call 24 hours a day, 7 days a week. An answering service or other similar mechanism that allows callers to obtain information from a live person, may be used for after-hours and weekend coverage. 3.7.2.1 HMO must provide coverage for the following services at least during HMO's regular business hours (a minimum of 9 hours a day, between 8 a.m. and 6 p.m.), Monday through Friday: 1. Member ID information; 2. PCP Change; 3. Benefit understanding; 4. PCP verification; 5. Access issues (including referrals to specialists); 6. Unavailability of PCP; 7. Member eligibility; 8. Complaints; 9. Service area issues (including when member is temporarily out-of-service area); and 10. Other services covered by member services. 3.7.2.2 HMO must provide HHSC with policies and procedures indicating how the HMO will meet the needs of members who are unable to contact HMO during regular business hours.
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Related to Member Helpline

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