HOW TO Guide

Transcription

HOW TO Guide

CareMore’s
HOW TO Guide
HOW2LASCCNT14
Y0017_14_111308A CHP CMS Accepted (11062013)
WELCOME TO CareMore
This How To Guide was created as
a quick reference to help you make
the most of your membership in
CareMore Health Plan. In this book,
you will find answers to frequently
asked questions, as well as important
telephone numbers that we think will
be the most relevant to you as a new
CareMore member. We recommend
that you hang onto this How To Guide
as it may be useful in the months to
come. Please refer to your Evidence
of Coverage or call Member Services
if you cannot find the answer you’re
looking for in this guide.
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract and a contract with the Medi-Cal program.
Enrollment in CareMore Health Plan depends on contract renewal. The benefit information provided is a brief summary,
not a complete description of benefits. For more information contact the Plan. Limitations, copayments and restrictions
may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January
1 of each year. This information is available for free in other languages. Please contact our Member Services number
at 1-800-499-2793, TDD/TTY users call 711. 8 a.m. - 8 p.m., seven days a week (October 1 through February
14, except Thanksgiving and Christmas) and Monday through Friday (except holidays) from February 15 through
September 30. Esta información esta disponible gratis en otros idiomas. Por favor comuníquese con el servicios para
los miembros al 1-800- 499-2793, TDD/TTY deben llamar al 711, de 8 a.m. a 8 p.m., los 7 días de la semana
desde el 1 de octubre hasta el 14 de febrero (excepto el Día de Acción de Gracias y Navidad), y de lunes a viernes
(excepto los días feriados) desde el 15 de febrero hasta el 30 de septiembre. CareMore Connect (HMO SNP) is a
Special Needs Plan available to anyone who has both Medical Assistance from the State and Medicare.
TABLE OF CONTENTS
Now that I’m a Member...
Does enrolling with CareMore mean
I’m losing my Medicare coverage?...............
2
Will I get a CareMore membership card?..... 2
Health Services
12
What if I move?..................................... 12
What if my PCP leaves the Plan?.......... 13
How do I change my PCP?..................
What do I do with my red, white
and blue Medicare card?.............................
2
If I’m not using the Medicare card, do I have
to keep paying the Part B premium?............
2
Who will tell my previous Medicare plan
and/or Primary Care Provider (PCP) that
I have switched to CareMore?.....................
3
If I choose a new PCP, how will my
medical records be transferred to
my new PCP?.............................................
3
15
What should I do in an emergency?...... 16
4
What happens when I need
urgent care?.........................................
16
What urgent care facilities or
emergency rooms can I use?................
17
How do I know if I qualify for a
Low-Income Subsidy (LIS)?.........................
How can CareMore help me find
other assistance programs I might
qualify for?...................................................
What is Healthy Start
4
?............................... 5
™
What are Referrals and when are
they required?......................................
13
What services can I get without a
Referral (or Prior Authorization)?...........
14
How can I get a second opinion?......... 15
Where do I go for X-rays or
lab services?........................................
How can I make sure I keep my durable
medical equipment (DME), like my
bed, oxygen and wheelchair, as
long as I need it?..................................
17
How do I use my Exercise and Strength Training Benefit?.....................
18
How do I use my Vision Benefit?.......... 19
CareMore Care Centers
What is a CareMore Care
Center (CCC)?.............................................
8
How do I find out about
special events at the CCCs?........................
8
What services are available
at the CCC?................................................
9
How do I make a CCC
appointment?...........................................
10
How do I use my Basic Dental
Benefit?................................................
20
TABLE OF CONTENTS
Other Benefits of
Membership
Plan Documents
What Are CareMore’s Caring
Extras?................................................
24
Can CareMore Help Me Get To
My Appointments? .............................
25
Where can I go for copies of my
Evidence of Coverage, Formulary
and Directory?.....................................
34
How may I request materials in
alternate formats?...............................
34
How do I download my
Evidence of Coverage, Formulary
and Directory?.....................................
34
Medication and Supplies
How do I find out what
drugs are covered?.............................
28
What is a pharmacy network?............ 28
How do I use CareMore’s
mail-order pharmacy?......................... 29
How do I request a
formulary exception?.......................... 30
What is the difference between
brand and generic drugs?.................. 30
What do my drugs cost?.................... 30
Am I covered for prescription
drugs in the coverage gap
(“donut hole”)?....................................
31
How do I get my diabetic
monitors and supplies?...................... 31
What programs can help me
manage my medications?................... 32
Where to Call
I want to refer a friend to CareMore.
Who should they call?.........................
36
What if my questions have not been
answered in this guide, or if I need
additional help?...................................
36
Important Phone Numbers.................. 37
Where is my closest CCC?.................. 38
+
Additional Information
43
CareMore’s Caring Extras.................... 47
Fraud, Waste & Abuse......................... 59
Nifty after Fifty......................................
NOW THAT I’M
A MEMBER...
2
Does enrolling with CareMore mean I am losing
my Medicare coverage?
No, it doesn’t. You are enrolling in a Medicare Advantage health plan, but
you are still in the Medicare program, as you must have Medicare Part A and
Part B to enroll with CareMore. Our members receive all of the benefits Original
Medicare offers, in addition to many more.
Will I get a CareMore membership card?
Yes. You may have already received your CareMore member ID card – or, you
will get it soon. Keep this card with you at all times. You will need to present your
CareMore membership card at all of your medical appointments and pharmacies.
The card has information that your provider will need to bill us after you get care.
It also has our Member Services number if you need to call us. If you misplace
your membership card, please call Member Services to request a new card.
What do I do with my red, white and blue
Medicare card?
As long as you are a member of CareMore, you must not use your red, white,
and blue Medicare card to get covered medical services (with the exception
of routine clinical research studies and hospice services). Keep your red,
white, and blue Medicare card in a safe place in case you need it later.
If I’m not using the Medicare card, do I have to
keep paying the Part B premium?
+
Yes, you do. Medicare requires you to continue paying your Medicare Part B
premium if not otherwise paid for under Medicaid or by another third party, such
as a former employer. If you meet certain eligibility requirements for both Medicare
and Medicaid, your Part B premiums may be covered in full. In order to be eligible
for our plan, you must maintain your eligibility for Medicare Parts A and B. Your
Part B premium is in addition to paying any applicable CareMore plan premiums.
CareMore’s How To Guide
CareMore Health Plan
3
Who will tell my previous Medicare plan and/or
Primary Care Provider (PCP) that I have switched
to CareMore?1
If you were already enrolled in a Medicare Advantage plan, Medicare will notify
your previous health plan that you are disenrolling from their plan upon your
enrollment with CareMore. No action whatsoever is required on your part.
However, if you were enrolled in a Medicare Supplement Plan, you will need to
inform your previous plan that you’re switching to CareMore and want to disenroll.
If you are also switching to a new CareMore PCP, there is no need to contact
your previous doctor. Simply present your new CareMore membership card to
your new PCP at your next office visit.
If I choose a new PCP, how will my medical
records be transferred to my new PCP?1
When you enrolled, you may have signed the Authorization for Use or
Disclosure of Protected Health Information form. If not, you can request
the transfer of your medical records by signing the Authorization for Use or
Disclosure of Protected Health Information at your new PCP’s office. They
will then work to transfer your records. If you prefer, you may instead bring the
records with you to your new PCP’s office. You may also contact Member
Services to request that a copy of the Authorization for Use or Disclosure
of Protected Health Information form be mailed to you.
You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations, for
out-of-area dialysis services or when CareMore authorizes use of out-of-network providers. If you obtain routine care
from out-of-network providers, neither Medicare nor CareMore will be responsible for the costs.
1
CareMore Member Services
1-800-499-2793 (TTY users should call: 711)
8 a.m. - 8 p.m., 7 days a week (October 1 – February 14) and Monday – Friday (February 15 – September 30)
+
4
How do I know if I qualify for a Low-Income
Subsidy (LIS)?
Medicare provides “Extra Help” to pay prescription costs for people that
have limited income or resources. If you qualify, you’ll get help paying for any
Medicare drug plan monthly premium, yearly deductible and prescription
copayments. “Extra Help” also counts toward your out-of-pocket costs.
Some people automatically qualify for “Extra Help” and don’t need to apply.
Medicare mails a letter to people who automatically qualify. Currently, only
about 30% of those who qualify take advantage of this program.
To see if you qualify for “Extra Help,” call one of the phone numbers
listed below.
CareMore has contracted with My Advocate to help our members determine
if they qualify for “Extra Help.”
• My Advocate: 1-866-242-1285 (9 a.m. to 6 p.m. EST, Monday–Friday); or
• Medicare: 1-800-MEDICARE (1-800-633-4227); TDD/TTY users
should call 1-877-486-2048 (24 hours a day, 7 days a week); or
• Social Security: 1-800-772-1213; TDD/TTY users should call
1-800-325-0778 (7 a.m. to 7 p.m., Monday–Friday); or
• Your state Medicaid office
How can CareMore help me find other
assistance programs for which I might qualify?
You may qualify for additional federal, state and local social
programs that you are unaware of. For guidance on eligibility, call:
• My Advocate: 1-866-242-1285 (9 a.m. to 6 p.m. EST, Monday–Friday)
+
5
What is Healthy Start™?1
Once you’re enrolled, we’ll schedule you for a Healthy Start™ appointment. A
Healthy Start™ appointment is how CareMore learns everything we need to know
about your health. It’s how we assess your personal needs and plan for
your individual care. Our goal: to build a healthy relationship with you through
our benefits and unique health programs.
Your Healthy Start™ appointment begins at your local CareMore Care Center
(CCC) with a head-to-toe comprehensive personalized assessment of your
medical and psychosocial needs. We detect chronic conditions, evaluate
your medications, conduct lab tests and provide on-site lab results. We’ll ask
questions regarding your health history to find out which areas of your health
and lifestyle are satisfactory to you and which areas you want to improve.
Through Healthy Start™, our clinical team will be able to make specific
recommendations about your care and tailor a plan to meet your individual needs.
At the end of your Healthy Start™ assessment, you’ll receive a personalized care
plan that summarizes your overall health status. This plan offers preventive and
proactive recommendations for your follow-up care. And we’ll forward it to your
PCP so that everyone involved in your care knows exactly what you need.
To best understand your health, we need you to bring the following (if
applicable) with you to your Healthy Start™ appointment at the CCC:
• CareMore membership ID card.
• Any prescription and
over-the-counter medications.
Please bring the actual bottles.
• Your prescription eyeglasses.
• An ESRD report card from
the dialysis center.
• Your glucometer.
• Any questions you may have
regarding your care.
+
6
+
1
CAREMORE
CARE CENTERS
8
What is a CareMore Care Center (CCC)?
CareMore Care Centers are much more than just a doctor’s office or clinic.
Owned and operated by CareMore, the CareMore Care Centers offer
comprehensive personalized health care – as well as an array of programs that
combine medical supervision with nutrition, exercise and social activities to
enhance your overall wellness.
At the CCC, we take our time with you, and offer access to a highly qualified and
specially trained staff of providers who understand proactive, integrated care.
Our goal is your total health, so we aim to prevent and detect disease when it’s
more curable and easier to treat. Some of our specialized programs include a
Healthy Start™ health assessment, diabetes education and a foot care center1.
CareMore Care Centers are also meeting places where you may see old friends
and make new ones. Visit a smoking cessation clinic. Join a class to learn more
about your chronic condition – or Healthy Living. There’s a lot going on at the CCC!
How do I find out about special events at
the CCCs?
The best way to find out about events at your local CCC is to call them
using the numbers listed on pages 38-40 of this How To Guide. As a
CareMore member, you will also receive a subscription to CareMore Chronicles,
our newsletter, with information about CareMore activities and events, as well as
staying healthy.
Not available at all CareMore Care Centers.
1
Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 each
year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply.
2
+
3
9
What services are available at the CCC?1, 2, 3
The following services do not require a Referral or Prior Authorization, but may
require advanced scheduling, so call your local CCC to make an appointment. Not
all services are available at every CCC so check your local center to see what is
offered. Phone numbers are listed on pages 38-40 of this How To Guide.
• Chronic Obstructive Pulmonary Disease (COPD) Program – Education,
information and self-management techniques to improve well-being.
• Congestive Heart Failure (CHF) Program – Education, nutritional training,
medication management, physical activity, blood pressure monitoring, limiting
sodium intake. Close collaboration with your plan cardiologist.
• DiabeatIT™ (CareMore’s Diabetes Management Program) – Nutritional
education and counseling, including blood sugar control; diabetes support
groups, exercise classes and a toll-free helpline.
• Educational Classes – Series of classes on healthy living and chronic
disease management.
• Exercise & Strength Training – Strength training coupled with a balancetraining program to increase muscle strength.
• Fall Prevention Program – Comprehensive assessment, education and
evaluation for people with a history of or who are at risk for falls.
• Healthy Start™ – Comprehensive physical and psychosocial evaluation
performed by a specially trained Nurse Practitioner with recommendations and
choices for treatment and follow-up care.
• Healthy Journey – Annual head-to-toe assessment (physical exam, medication
evaluation, pain assessment, onsite labs) for members of CareMore’s Special
Needs Plans, including Heart, Breathe, Diabetes, Reliance, Connect and ESRD.
• Nutritional Consultation – Education, self-management, clinical and dietary
management and maintenance of appropriate weight levels and physical activity.
• Foot Care Center – Medical podiatry care, regular foot examinations, routine
toenail trimming and callus removal.
• Smoking Cessation Program – Education and encouragement on most
effective ways to stop smoking; medication treatment and management may be
part of personalized program.
+
10
• Wound Care Program – Wound evaluation, medical history review,
individualized wound care treatment and supplies.
The following services may require a Referral or Prior Authorization:
• Anti-Coagulation Clinic1 – Education and training about medication side
effects, food-drug interactions, safety, dosing instructions; counseling, on-site
testing and immediate reporting.
• Chronic Kidney Disease (CKD) Care Program1 – Health evaluations and risk
assessment to support your complex needs; close collaboration with a
plan-approved nephrologist.
• Hypertension (HTN) Program1 – Daily home electronic monitoring of
member’s blood pressure; educational classes, support groups and periodic
wellness checkups.
• Pre-Op Surgery Evaluation – Clinical assessment of members scheduled for
surgery, to avoid potential medical complications.
• Post Hospitalization Exam – Clinical assessment of health status
following hospitalization.
How do I make a CCC appointment?
Call your nearest CareMore Care Center (CCC) to schedule an appointment
for programs and services that do not require a Referral or Prior Authorization.
You can log onto www.caremore.com or refer to pages 38-40 of this
How To Guide for a listing of local CCC phone numbers. For more information
about referrals and prior authorization, please see pages 13-14 in this guide.
+
Not all services/programs are available in every CCC. Exercise and
strength training classes may be offered at the CCC or at a separate
vendor facility, depending on your location. Your Provider/Pharmacy
Directory identifies what programs and services are available at your local
CCC. Or, you can call your local CCC to find out what programs and
services are available (the numbers are listed on pages 38-40).
Not available at all CareMore Care Centers.
1
HEALTH
SERVICES
12
Health Services
How do I change my PCP?1
You may change your PCP to another PCP within CareMore’s network
for any reason (for example, if you become unhappy with your current
PCP). Check your Provider/Pharmacy Directory for options, and when
you find a provider that you’d like to sign up with, call Member Services
to find out if the PCP you have selected is accepting new patients.
Member Services will change your membership records to reflect the name
of your new PCP, and will tell you exactly when the change to your new
PCP is expected to take effect. They will also send you a new membership
card that reflects the name and phone number of your new PCP.
Any change of PCP made before the last business day of the month
will become effective the first day of the following month. Please
note that business days do not include weekends or holidays.
What if I move?
If you plan on moving your place of residence, please be sure to call Member
Services. They can help you to determine what this move means to your
current coverage. If you are moving within your coverage area, we will
update your membership record so we know how best to contact you. If
you are moving into another CareMore coverage area, Member Services
will discuss any change that may take place regarding your coverage.
However, if you are permanently moving out of a CareMore coverage area, you
must do the following:
• Call Member Services to notify them that you are leaving the plan.
When you are disenrolled, you will become eligible to enroll in a new plan in
your new area.
+
• Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day,
7 days a week (TTY users should call 1-877-486-2048) to request a
Special Election Period, followed by a call to Social Security Administration
at 1-800-772-1213 (TTY users should call: 1-800-325-0778),
7 a.m. – 7 p.m., Monday–Friday to notify them of your address change.
Health Services
13
What if my PCP leaves the plan?1
This does happen from time to time, and you will have to switch to a new PCP.
CareMore will automatically assign you to a new PCP; however, you have the
option to change to another PCP, if you like. Simply call Member Services
to select another PCP. If your specialist leaves the plan, we will also direct you
to another specialist. You can also find a list of PCPs and specialists in your
Provider/Pharmacy Directory or visit www.caremore.com for options.
We’ll make sure that the PCP or Specialist you have selected is accepting new
patients. If he/she is, our Member Services Representative will change your
membership records and send you a new membership card with updated
contact information. Member Services will also advise you when this change
will take effect.
What are Referrals and when are they required?1
You will receive your routine or basic care from your PCP. To get specialty
services or to see a CareMore contracted specialist, you must get approval in
advance from your PCP, a CareMore Extensivist or Nurse Practitioner, or another
specialist (this is called getting a “referral”). Your PCP, CareMore Extensivist or
Nurse Practitioner, or specialist will then coordinate to obtain approval in advance
from CareMore (this is called getting “prior authorization”). An extensivist is a
physician who generally splits his time between the hospital, where he rounds
on a small group of members each day, and an outpatient clinic, where he
sees recently discharged and other members at high risk of admission.
Sometimes – depending on your medical and social needs – your PCP
will refer you to specialists and programs at your local CCC to provide you
with additional resources to meet your health care needs. Our CCCs have
a variety of disease management programs and many specialists on staff
such as a podiatrist, nutritionist, pulmonologist, cardiologist, dermatologist
and more. If our CCC does not offer the services you need, you may be
referred to a CareMore network specialist who can provide these services.
1
+
14
Health Services
It’s very important to obtain proper approval from your PCP or CareMore
before you see a contracted specialist or receive specialty services.
If you do not have a Referral or Prior Authorization before you receive
services, you may have to pay for these services yourself.
Please remember that when you select your PCP, you are also choosing the
hospitals and specialty networks associated with your PCP. CareMore organizes
its provider network into “neighborhoods” to help promote a community based
approach to health care. When you choose a PCP, you will be referred to
the specialists, hospitals and other providers associated with your PCP and
neighborhood. If there is a particular plan specialist or hospital that you want
to use, check first to be sure that specialist or that hospital is in the same
neighborhood as your PCP.
What services can I get without a Referral
(or Prior Authorization)?1, 2
For most of your routine healthcare needs, you will usually see your PCP first.
However, there are a few types of covered services you may get on your own.
These are known as self-referrals. You may receive the following services
without getting approval in advance from your PCP, as long as you get them from
a network provider:
• Flu shots
• Hearing exams
• Men’s prostate cancer
screening exams
• Routine eye exams
• Annual wellness exams
+
• Nutritional consultations
(at the CareMore Care Center)
• Routine women’s health care,
including breast exams, screening
mammograms (X-rays of the breast),
Pap tests and pelvic exams
• Urgently needed care
Of course, emergency services are available (without a Referral or Prior
Authorization) from either network or out-of-network providers. You may also
self-refer to other services such as:
Health Services
15
• Kidney dialysis (when network providers are temporarily unavailable
or inaccessible). If you’re planning to travel, call Member Services
to arrange for maintenance dialysis while you’re away.
• Exercise and strength training programs (at plan-approved locations)
• Healthy Start™ appointments (at the CCC)
It’s always a good idea to refer to your Evidence of Coverage to find out the
specific rules for Referrals & Prior Authorizations. See Chapters 3 and 4 for more
information.
How can I get a second opinion?1
You are entitled to a second opinion by another physician within our network.
You may contact your PCP to have them submit an authorization request or
contact Member Services for assistance.
Where do I go for X-rays or lab services?1, 2
For X-rays and lab services, you will need to obtain a request form from your
treating provider.
Call Member Services or visit www.caremore.com to get the address of
the contracted facility nearest to you. Your provider can also refer you to a
contracted radiology facility or laboratory.
1
2
+
16
Health Services
What should I do in an emergency?1
Medical emergency = When you believe that your health is in serious danger.
A medical emergency can include severe pain, a bad injury, a sudden illness or
a medical condition that is quickly getting much worse.
In a medical emergency, you should:
• Get help as quickly as possible. Call 911 or go to the nearest emergency
room or hospital.
• Tell CareMore about your emergency as soon as possible. We need to follow
up on your emergency care.
You’re covered for emergencies anywhere in the United States or its territories.
CareMore offers limited supplemental emergency coverage when you’re out of
the country. Check your Evidence of Coverage, Chapter 4, for more details.
What happens when I need urgent care?
Urgently Needed Care = When you need medical care right away, but your
health is not in serious danger. Urgent care may be required for an illness,
injury or condition that you did not expect or anticipate, but your health is not
in serious danger.
How you get urgent care services depends on where you are. In most situations,
if you are in the plan’s service area, we will cover urgently needed care only if you
get care from network providers.
If you are inside the service area, call your PCP. If your PCP office is closed,
you may go to any Urgent Care Center located in our service area. Before you
need urgent care, it is a good idea to check your Provider/Pharmacy Directory or
call Member Services to locate an Urgent Care Center near you.
If you are outside the service area, CareMore will cover urgently needed care
that you get from any provider.
+
You’re covered for urgent care anywhere in the United States or its territories.
CareMore also offers limited supplemental urgently needed medical care
coverage for occasions when you are outside of the United States. Please
refer to your Evidence of Coverage, Chapter 4, for more information.
Health Services
17
What urgent care facilities or emergency
rooms can I use?2
You can find a listing of CareMore’s contracted urgent care facilities and hospitals
in your Provider/Pharmacy Directory or by visiting www.caremore.com. If your
situation is life threatening, you should go to the nearest emergency room.
How can I make sure I keep my durable
medical equipment (DME), like my bed, oxygen
and wheelchair, as long as I need it?1
When you signed up with CareMore, your sales representative should have
assisted you in filling out the forms necessary to begin care with us. One of
the forms that must be completed is a Continuity of Care form. This form ensures
that we have the information necessary to properly transition your existing DME
services to CareMore.
If you did not complete a form or you have obtained new DME since enrolling but
prior to your effective date, you may call Member Services for assistance. You
can also learn more about your DME benefit by referring to your Evidence of
Coverage, Chapter 4.
If you need new DME, please contact your PCP so he or she can submit a
service request based upon your needs.
1
2
+
18
Health Services
How do I use my exercise and strength
training benefit?1, 2
Staying active is key to good health. That’s why we encourage our members to
keep moving!
CareMore members can access
several facilities that provide
specialized fitness and training
programs. If you’re already exercising,
you’ll enjoy the fun, friendly
atmosphere and special programs
to keep you strong and healthy,
as well as enhance your flexibility,
strength and cardio endurance.
If you’re just starting an exercise
routine – or you have some physical
limitations – we’ve got medicallysupervised programs to improve
and increase muscle strength,
balance, mobility, flexibility and
overall fitness. Just remember
to check with your doctor
before starting any exercise program.
Nifty after Fifty
Created by a doctor, Nifty after Fifty
helps you keep or regain strength,
flexibility, balance and mental
sharpness. It is another program
available to members of all CareMore
plans, except CareMore Touch
(HMO SNP). No ordinary gym, it’s
a unique approach to wellness with
personally supervised physical and
mental fitness programs that help
you maintain your independence and
increase your zest for life.
For more details, please see our Nifty
after Fifty brochure on page 43.
Among the program features:
• Exercise classes specifically designed for our members.
• First visit orientation and training to learn how to use the exercise equipment.
• Supervision by physical therapists or fitness coaches who develop
a personalized plan for each member.
+
Just call Member Services to find a location near you.
Health Services
19
How do I use my vision benefit?1, 2
It’s important to take care of your eyes – and CareMore’s vision benefit helps
you do that.
You can self-refer for routine eye exams performed by network optometrists–
and you’re covered for eyewear. Check your Evidence of Coverage, Chapter
4, for detailed information about your vision and eyewear benefits.
Routine vision services are offered by the following vision providers:
• California: UniView Vision Insight
• Arizona: Block Vision / Eye Specialists
• Nevada: Nevada EyePA
Other vision services, such as those covered by Medicare, require Prior
Authorization from your PCP. These include services to diagnose and treat
conditions of the eye or visits to an ophthalmologist.
You may self-refer to any vision provider that participates in your vision plan for
routine eye exams and eyeglasses. Check your Provider/Pharmacy Directory for a
listing of participating providers in your area.
1
2
+
20
Health Services
How do I use my basic dental benefit?1, 2, 3
Healthy teeth keep you smiling – and that’s important to both your physical and
mental health!
Basic Dental coverage is included in your CareMore health plan – and it’s
easy to see a dentist. Simply refer to the Basic Dental section of your Provider/
Pharmacy Directory, select a general dentist and call for an appointment.
With no deductible and no annual maximum, your Basic Dental coverage
offers low copayments for oral exams, cleanings, fluoride treatments and
X-rays. You can find out what your copay will be for many dental procedures
by referring to the 2014 Chart for Basic Dental Benefits in this Welcome
Kit. For more information, check your Evidence of Coverage, Chapter 4.
With the Basic Dental plan, you will enjoy savings on many dental
procedures.3 For example:
+
Health Services
ADA
Code
D0120
D1110
D0180
D0330
D2140
D2330
D2740
D2790
D3310
D4341
D5110
D5410
D7220
Procedure
Periodic Oral Evaluation
Prophylaxis (cleaning) – 2 per year
Comprehensive Periodontal Evaluation
– new or established patient
Panoramic Film
Amalgam, 1 surface, primary or permanent
Resin based composite – one surface, anterior
Crown – porcelain/ceramic substrate
Crown – full cast high noble metal
Endodontic therapy, anterior tooth
(excluding final restoration)
Periodontal scaling and root planning –
four or more teeth per quadrant
Complete denture – maxillary
Adjust complete denture – maxillary
Removal of impacted tooth – soft tissue
21
Basic Dental
Copay
$5
$35 each
$15
$10
$25
$40
$335
$430
$240
$80
$475
$28
$80
1
You must receive all routine care from network providers. Exceptions are in emergency or urgent care situations,for
2
3
This is only a sampling of Basic Dental copays. For a complete listing of Basic Dental copayments, please refer to the
2014 Chart for Basic Dental Benefits in your Welcome Kit.
+
22
Health Services
+
OTHER BENEFITS
OF MEMBERSHIP
24
Other Benefits of Membership
What are CareMore’s Caring Extras?
CareMore’s Caring Extras are value-added items and services that help
you save money. We understand that getting your health care through
CareMore solves many of your health care issues. But getting all the
health-related services you need at a reasonable cost can be difficult.
CareMore wants you to stay healthy. We have carefully selected our Caring
Extras partners to give you confidence in the services they provide. That’s why
we offer our members extra discounts on hearing, vision, fitness, dental, weight
management – and much more.
For more details about our Caring Extras programs and partners, please see
our CareMore’s Caring Extras Value-Added Items & Services listing on pages
47 through 58.
+
25
Can CareMore help me get to my appointments?
Yes. At CareMore, we make it easy for you to see your doctors – and other health
care providers. That’s why we offer a routine transportation benefit. Check
your Evidence of Coverage to understand what your specific plan covers.
Typically, transportation services are available during regular business hours –
9:00 a.m. to 4:00 p.m. Monday through Friday (excluding holidays). If you are
scheduled for dialysis treatment, transportation services are available seven days
a week (including holidays).
You must be able to use a standard mode of transportation – bus, van or
taxicab. And, you must be able to ride with other people. You can bring one
escort (who is at least 17 years of age). If you bring an escort, you must let the
Transportation Department know at least 24 hours in advance.
How to schedule or cancel a trip?
Call the CareMore Transportation Unit: 1-877-211-6687, 7:00 a.m. to 6:00 p.m.,
Monday through Friday (excluding holidays)
Transportation tips to remember?
• You must schedule transportation no less than 24 business hours prior to
your medical appointment.
• If you need to cancel, you must notify CareMore at least 24 business hours
prior to your scheduled ride. If your scheduled ride is not cancelled, it may
count towards your trip limit. (if you plan has a trip limit).
• If you need to cancel a Monday appointment, please call on Friday to make
sure the trip does not count towards your trip limit. (if your plan has a trip limit)]
When you schedule your appointment, you need to confirm that:
• You can see the transportation vehicle from the building.
• You can get from the building and into the transportation vehicle unassisted.
• Your scheduled ride allows time for you to be transported to and from your
appointment during the regular transportation business hours: 9:00 a.m. to
4:00 p.m. Monday through Friday (excluding holidays).
+
26
What happens when you’ve used up your transportation benefit?
If you have other transportation needs not covered under the plan, additional
local transportation resources may be available to assist you with your travel
needs. These community-based services are not affiliated or contracted with
CareMore. They usually charge a nominal fee and have specific eligibility
requirements.
Please refer to the Community-Based Transportation Services insert in this
Welcome Kit for more information.
+
MEDICATION
AND SUPPLIES
28
How do I find out what drugs are covered?1
To find out what drugs are covered, you can look at CareMore’s 2014 Formulary
(List of Covered Drugs) included in this Welcome Kit. A drug formulary is a list of
drugs covered. It also includes such information as quantity limits.
CareMore does not cover all brand or generic prescription drugs. If the drug is
not listed in the formulary, it is not covered. In some cases, the law does not
allow any Medicare plan to cover certain types of drugs. In other cases, we
have decided to not include a particular drug on the formulary. Please check
the online formulary at www.caremore.com for the most up-to-date list.
To get a copy of the CareMore’s 2014 Formulary, call Member Services or
visit www.caremore.com.
What is a pharmacy network?
A pharmacy network is a group of pharmacies that are contracted to provide
prescription medications to our members. Your formulary prescription drugs are
covered at these pharmacies. As a member of CareMore, you have access to
more than 69,000 network pharmacies across the country.
+
29
How do I use CareMore’s mail-order pharmacy?1
CareMore’s mail-order pharmacy is provided through Walgreens. In order to be
eligible for mail-order services, you must order at least a 90-day supply, (30-day
supply for Tier 5 Specialty Drugs). You can sign up with Walgreens mail service
over the phone, online or by mail. The phone number is: 1-800-RX-REFILL
(1-800-797-3345).
To receive order forms and information regarding filling your prescriptions by mail,
please call Member Services or visit www.caremore.com to download them.
How to download mail-order forms:
• Visit www.caremore.com
• Click the Current Members tab
• Click the Drug Formulary and Pharmacy tab
• Click Walgreens Prescription Order Form
• Select either the “by mail” or “by fax” order form – the contact information you
need is located on the forms.
You must send the Walgreens mail service form and your prescription (you may
mail them your prescription yourself, or request to have your prescribing provider
phone in or fax in the prescription on your behalf).
This year, each time you get an automatic refill, the mail order pharmacy will contact
you first to ensure that you want to continue receiving this specific medication.
Usually, a mail-order pharmacy order will arrive in 14 days. However, your mail
order may sometimes be delayed. If your mail-order prescription is delayed for
some reason, you may still obtain your medication from your local pharmacy. Your
local pharmacy will simply contact CareMore to get permission to temporarily
fill up to a 30-day supply of your prescription. Your normal copay will apply.
NOTE: If you use a mail-order pharmacy other than Walgreens, your prescription
will not be covered.
*Other pharmacies are available in our network.
1
+
30
How do I request a formulary exception?
If you are currently taking a drug that is not on the formulary, you (or your
representative, your PCP or other prescriber) can request a formulary
exception. This means you are asking for us to cover your drug, even
though it is not on the formulary. First, speak with your doctor or
other prescriber about covered alternatives. If there are no alternative
medications and your doctor or other prescriber believes that you have
medical reasons that justify an exception, you, your representative, your
doctor or other prescriber should contact Member Services.
What is the difference between brand and
generic drugs?1
A generic drug is a prescription drug that has the same active ingredients as
the brand name drug. The generic drug works just as well as the corresponding
brand name drug but costs less. There are generic drug substitutes available
for many brand name drugs. If you are currently taking a brand name drug
and would like to switch to a generic version, ask your doctor if a generic
option of your brand name drug is available and right for your care.
What do my drugs cost?
The formulary includes both brand name and generic drugs. Every drug on
the formulary belongs to one of six cost-sharing tiers. In general, the higher the costsharing tier, the higher the cost for your drug. Generic drugs are in the lowest tiers and
are the least expensive drugs for you. Brand drugs are more expensive and are in the
higher tiers. However, Select Care drugs (Tier 6) have a low-cost copayment.
Please refer to your Evidence of Coverage, Chapter 6, for your
specific drug costs.
+
1
31
Am I covered for prescription drugs in the
coverage gap (“donut hole”)?
Most CareMore plans offer coverage in the coverage gap. Please check your Evidence
of Coverage, Chapter 6, for detailed information about your Plan’s coverage in the gap.
In addition, CareMore members can enjoy the savings from the Medicare
Coverage Gap Discount Program while in the coverage gap. Refer to your
Evidence of Coverage for details.
You can expect additional savings on your brand name and generic drugs in the
coverage gap over the next six years until the coverage gap is closed in 2020.*
How do I get my diabetic monitors and supplies?1
If needed for your condition, you may receive your diabetic supplies at the
time of your Healthy Start™ appointment, if available. Otherwise, you will receive
a prescription that can be taken to a local pharmacy for your glucometer, lancets
and test strips. Your PCP can give you a prescription to be filled at the pharmacy.
CareMore covers the following diabetic monitors and their corresponding test strips:
• FreeStyle Lite
• FreeStyle Freedom Lite
• FreeStyle InsuLink
With these monitors, Caremore can track your insulin count and share this
information with your PCP. CareMore and your PCP will use this information to
help you best manage your diabetes.
*Reference: www.Medicare.gov
+
32
What programs can help me manage my
medications?
We have programs that can help you with special situations – if you have several
complex medical conditions, take many drugs at the same time or have very
high drug costs.
Voluntary and free to you, these programs were developed by a team of pharmacists
and doctors. Their goal: to make sure you are using the drugs that work best to treat
your medical conditions and help us identify possible medication errors.
One program is called a Medication Therapy Management (MTM) program. If you
take several medications for different medical conditions, you may qualify. If you qualify
for this program, CareMore will notify you by mail and then follow-up with a phone call
by a pharmacist. In the MTM program, a pharmacist gives you a comprehensive review
of all your medications. You can talk about how best to take your medications, your
costs or any problems you’re having.
You’ll get a written summary of this discussion. The summary has a medication action
plan that recommends what you can do to make the best use of your medications,
with space for you to take notes or write down any follow-up questions. You’ll also get
a personal medication list that will include all the medications you’re taking and why
you take them. We hope that you to accept this offer to review your medications.
If we have a program that fits your needs, we will automatically enroll you in the
program and send you information. If you decide not to participate, please notify us
and we will withdraw you from the program. If you have any questions about these
programs, please contact Member Services.
+
1
PLAN
DOCUMENTS
34
Plan Documents
Where can I go for copies of my Evidence of
Coverage, Formulary and Directory?
Copies of your Evidence of Coverage, Formulary and Directory are included in
this Welcome Kit. If you need additional copies, you may obtain them online at
www.caremore.com. You may also contact Member Services to request any
of these materials to be mailed to you.
How may I request materials in alternate
formats? What alternate formats are available?
You may contact Member Services to request materials in alternate formats.
We can provide certain materials (usually the Evidence of Coverage, Formulary
and Provider/Pharmacy Directory) in large print, braille or languages other
than English. You may also log onto the Plan’s website www.caremore.com
to obtain both English and Spanish language materials.
How do I download my Evidence of Coverage,
Formulary and Directory?
1 STEP ONE
Visit www.caremore.com
4 STEP FOUR
Select Plan Materials
2 STEP TWO
Select Current Member tab
5 STEP FIVE
Indicate your specific
3 STEP THREE
Click Member Materials Tab
+
county and Plan
6 STEP SIX
Click button for items needed
NOTE: For Spanish, go to the blue bar at the top right corner of the
page and select [change] and then choose “Español”.
WHERE TO CALL
36
Where to Call
I want to refer a friend to CareMore. Who
should they call?
Your friend, or any other referral you may have, can call your sales representative
(if you have his or her phone number) or a CareMore Enrollment Specialist
at 1-877-211-6614 (TTY users should call: 711). 8 a.m. - 8 p.m., 7 days
a week (October 1 – February 14) and Monday – Friday (February 15 –
September 30) for assistance.
What if my questions have not been answered
in this guide, or if I need additional help?
Our Member Services representatives are ready and willing to help. Just call us
for further assistance. Or, you can refer to your Evidence of Coverage for more
detailed information.
+
Where to Call
37
Important Phone Numbers
CareMore Main Number
1-800-499-2793; TTY: 711
Care Center Appointments:
See pages 38 through 40
Plan-Specific Member
Services Numbers
CareMore Premium Billing
1-888-250-5800
(Option 5 / Member Eligibility)
CareMore Breathe
1-888-357-4166
CareMore Medical Assistance Numbers*
CareMore Connect
1-800-589-3146
24-Hour Hypertension (HTN)
Medical Assistance
1-888-458-1428
CareMore Diabetes
1-888-357-4187
CareMore ESRD
1-888-357-4177
CareMore Heart
1-888-494-8280
CareMore Reliance
1-800-589-3145
CareMore Touch
1-800-589-3147
CareMore Value Plus
1-800-822-6991
CareMore StartSmart Plus
1-800-822-8720
CareMore Healthy Start™
Appointments
1-888-291-1387
24-Hour Congestive Heart Failure
(CHF) Medical Assistance
1-877-874-8515
24-Hour Diabetes, Chronic Obstructive
Pulmonary Disease (COPD), End-Stage
Renal Disease (ESRD) and Connect
Medical Assistance
1-800-589-3148
Other Important Phone Numbers
Medicare
1-800-633-4227; TDD/TTY users should
call 1-877-486-2048
(24 hours a day, 7 days a week)
Understanding Eligibility for
Low-Income Subsidy through
My Advocate
1-866-242-1285 (9 a.m. to
6 p.m. EST, Monday - Friday)
Social Security Administration
1-800-772-1213; TDD/TTY users
should call 1-800-325-0778
(7 a.m. to 7 p.m., Monday - Friday)
*8 a.m.- 5 p.m. answered by live person; 5 p.m.- 8 a.m. answered by exchange and connected to clinician on call.
+
38
Where to Call
Where is my closest CCC?*
ARIZONA
Maricopa County
Pima County
750 E. Thunderbird Rd.
Phoenix, AZ 85022
1-602-866-1220
191 W. Esperanza Ave.
Green Valley, AZ 85614
1-520-791-7300
2330 N. 75th Ave.
Phoenix, AZ 85035
1-480-257-7500
7091 E. Speedway Blvd.
Tucson, AZ 85710
1-520-721-5777
5225 N. Scottsdale Rd.
Scottsdale, AZ 85250
1-480-429-3400
315 W. Irvington Rd., #101
Tucson, AZ 85706
1-520-294-1740
4821 N. Stone
Tucson, AZ 85704
1-520-314-3300
+
Addresses and phone numbers are correct as of January 1, 2014. For the latest listing of CareMore Care Centers in
your community, please call Member Services (see number below).
*
Where to Call
39
CALIFORNIA
Los Angeles County
10000 Lakewood Blvd.
Downey, CA 90240
1-562-862-3684
406 E. Colorado Street
Glendale, CA 91205
1-818-844-2778
15034 Imperial Hwy.
La Mirada, CA 90638
1-562-902-4929
4540 E. 7th St.
Long Beach, CA 90804
1-562-344-1150
3513 E. 1st St.
Los Angeles, CA 90063
1-323-859-2660
303 S. Union Ave.
Los Angeles, CA 90017
1-213-355-2600
301 N. Azusa Blvd.
West Covina, CA 91791
1-626-214-2600
14350 Whittier Blvd., #100
Whittier, CA 90605
1-562-696-1104
Orange County
1182 N. Euclid St.
Anaheim, CA 92801
1-714-399-9222
340 W. Central Ave., #110
Brea, CA 92821
1-714-529-3971
1325 N. Rose Dr., #102
Placentia, CA 92870
1-714-203-1767
1945 E. 17th St., #101
Santa Ana, CA 92705
1-714-888-8900
2444 W. Beverly Blvd.
Montebello, CA 90640
1-323-201-4130
15230 Hawthorne Blvd.
Lawndale, CA 90260
1-424-269-3600
+
40
Where to Call
CALIFORNIA
San Bernardino County
Stanislaus County
19059 Bear Valley Rd., #1
Apple Valley, CA 92308
1-760-515-5000
1234 McHenry Ave.
Modesto, CA 95350
1-209-544-2554
17083-17085 Main St.
Hesperia, CA 92345
1-760-981-1284
1000 Delbon Ave., #5
Turlock, CA 95382
1-209-664-7700
141 W. Foothill Blvd.
Upland, CA 91786
1-909-296-8800
Santa Clara County
255 N. White Rd., #200
San Jose, CA 95127
1-408-503-7600
4855 Atherton Ave., #101
San Jose, CA 95130
1-408-963-2400
7888 Wren Avenue #C-131
Gilroy, CA 95020
1-408-665-4400
+
NEVADA
Clark County
3085 E. Flamingo Rd., Ste. A
Las Vegas, NV 89121
1-702-436-0835
100 N. Green Valley Pkwy., #235
Henderson, NV 89014
1-702-754-2200
2601 N. Tenaya Way
Las Vegas, NV 89128
1-702-233-4950
ADDITIONAL
INFORMATION
+
+
42
ADDITIONAL INFORMATION
+
43
CareMore and Nifty after Fifty
Passionate About Health
You have many different health needs during
your lifetime, which is why CareMore (HMO
and HMO SNP) focuses so closely on
personal service. It’s also why we include
Nifty after Fifty* with our CareMore
Medicare Advantage plans.
The New You.
www.niftyafterfifty.com
*Nifty after Fifty is not a covered
program for CareMore Touch plans.
NAFFLY14
Y0017_14_101310A CHP CMS Accepted (10072013)
44See Positive Changes in Your Health
44
Created by a doctor, Nifty after Fifty helps you keep or regain strength, flexibility, and balance. It’s
no ordinary gym, it’s a unique approach to wellness with personally supervised fitness programs that help
you maintain your independence and increase your zest for life.
During your first visit to a Nifty after Fifty Center, your fitness level is assessed by one of our qualified
fitness coaches, who all have degrees in Kinesiology (the study of muscle function). Our coaches have
special training in the needs of mature adults and work closely with you to build your strength, balance
and flexibility.
State of the Art—yet simple
Nifty after Fifty uses a special Fitness Key for our Clinically Supervised
Full-Body Fitness program. Your key fits each exercise machine—showing
your personal goals while recording sets and repetitions. And through the
Fitness Key, your results and progress are monitored and adjusted.
Nifty after Fifty uses specialized equipment that can exercise every major muscle group—without creating
joint damage. Unlike a gym, all of our methods and exercises are designed to significantly improve your
range of capabilities and overall state of health.
Nifty After Fifty services include:
• Supervised Full-body Fitness customized
specifically for you
• Prescribed FitnessTM Programs addressing
specific chronic conditions
• Unique Muscle Training that boosts
every workout
• Fall Free® to enhance balance, flexibility,
and mobility
• Nifty People®: Social Connections
45
45
Nifty after Fifty fitness offers safe coaching support while building your strength, improving your
balance and increasing your endurance.
Interested in more info? Call 1-877-211-6614
Current CareMore members can call 1-800-499-2793.
(TTY users call 711) 8 AM - 8 PM
7 days a week, October 1 through February 14, (except Thanksgiving and Christmas)
and Monday through Friday, February 15 through September 30 (except holidays).
Nifty after Fifty is no charge
The New You.
to members of CareMore Medicare
Advantage plans.
46
46
The New You.
www.caremore.com
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health Plan depends
on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more
information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network,
premium and/or copayments/coinsurance may change on January 1 of each year. This information is available for free in other
languages. Please contact our customer service number at 1-800-499-2793, TDD/TTY users call 711. 8 a.m. - 8 p.m., seven
days a week (October 1 through February 14, except Thanksgiving and Christmas) and Monday through Friday (except holidays)
from February 15 through September 30.
Esta información esta disponible gratis enotros idiomas. Por favor comuníquese con el departamento de servicios al cliente al
1-800- 499-2793, TDD/TTY deben llamar al 711, de 8 a.m. a 8 p.m., los 7 días de la semana desde el 1 de octubre hasta el
14 de febrero (excepto el Día de Acción de Gracias y Navidad), y de lunes a viernes (excepto los días feriados) desde el 15 de
febrero hasta el 30 de septiembre.
47
47
CareMore’s Caring Extras
Value-Added Items & Services
Additional health services that save you money
VAISBRO14_POST_EN
CHP Int.101306A (10/13)
48
48
Valuable discounts on
health related services
Getting Medicare through CareMore (HMO and HMO SNP) helps you solve many of your
healthcare issues. But getting all of the health related services you need, at a reasonable cost,
can be difficult.
CareMore wants you to stay healthy. We have carefully selected our Caring Extras partners to
give you confidence in the services they provide.
That’s why CareMore provides its members valuable discounts on dental, hearing,vision, fitness
services—and much more!
The products and services described are neither offered nor guaranteed under our contract with the
Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes
regarding these products and services may be subject to the CareMore grievance process.
49
49
CALL TODAY to learn more
about all the special items &
services available through CareMore
1-800-499-2793
(TTY users call 711)
8:00 a.m to 8:00 p.m., 7 days a week
www.caremore.com
50
50
FAMILY & HOME
1-866-797-2333
http://slc.seniorlinkcare.com/partner/
panthem.html
Seniorlink Care is dedicated to assisting caregivers
to access the information needed in order to
understand service options, establish a plan for the
care of an elder, and receive expert advice from
eldercare professionals.
CareAdvisory service at a 15% discount:
$33.00 for 3 months or $84.00 for one year
Personal Emergency Response System
discount: $30/month and an initial $50
enrollment fee
Coupon code: Discount15
www.benefitscheckup.org/caremore.com
BenefitsCheckUp helps you enroll online
in public and private benefits programs.
Sponsored by the independent National
Council on Aging (NCOA), you can find local,
state and federal programs to help with
expenses such as prescription drugs, rent,
heating bills, meals and more.
Completing a BenefitsCheckUp questionnaire
is free and your answers are kept private. If you
don’t have a computer, visit the local library or
a senior center or ask a friend, relative or family
member to help.
1-800-800-0517
Medical Alarm is a personal emergency response system unit that can allow you to live more
independently. This device provides round-the-clock monitoring. In the event of an emergency, you simply
press a button located on a pendant that is worn around your neck or wrist.
A dedicated Medical Alert team is available to aid CareMore members in both emergency and nonemergency situations, 24 hours a day. CareMore members will receive a discount on the monthly
monitoring agreement. CareMore members will pay $24.95 per month for the following benefits:
State-of-the-art, plug-and-go approved medical alarm unit
Help at a push of a button
Two-way voice communication specifically designed to assist the hearing impaired
Lifetime Warranty — No service or repair costs incurred by the customer
Power supply with battery backup
Telephone connection cord
Waterproof emergency neck pendant
NO activation fee
NO long-term contract
51
51
1-866-413-8669
www.greatcall.com
GreatCall starts you out with the Jitterbug Plus®, a high-quality, durable phone with large, backlit
buttons, bigger numbers, and effortless navigation combined with friendly, U.S.- based customer
support. GreatCall then helps you stay healthy with LiveNurse (24/7 unlimited access to registered
nurses) and Medication Reminders (a free prescription reminder service).
Call now to receive:
$20 off the price of the Jitterbug Plus
FREE shipping
FREE LiveNurse Advice Line
FREE Medication and Prescription Reminder Service
FREE Car changer
1-866-242-1285
https://MyAdvocateHelps.com
You may be eligible for free financial assistance toward your healthcare costs through My Advocate (formerly
Social Service Coordinators). Each year, My Advocate helps Medicare Advantage members with enrollment
into Medicare Savings Programs (MSPs).
Medicare Savings Programs (MSP) – Provides education and assistance free of charge to CareMore
members for applying and enrolling into MSPs, which may pay your Medicare Part B premium.
Medicare Part D Extra Help – Provides assistance to CareMore members with applying and
enrolling into Medicare Part D’s Low-Income Subsidy (LIS) also known as “Extra Help”.
MSP Recertification – Offers services to help CareMore members enroll into an MSP, whether or
not they used My Advocate to help them enroll previously. My Advocate helps members complete the
annual process of re-applying through the state Medi-Cal/Medicaid administration – the Department of
Health Care Services – to maintain their MSP.
MyAdvocateHelps.com – Helps CareMore members learn about the numerous money-saving and
community assistance programs that are specifically available for them that assist with:
Utilities (phone, heat and electricity)
Transportation
Nutrition and food assistance
Prescriptions
And much more
Visit MyAdvocateHelps.com today to see
how My Advocate might help you with
these programs.
52
52
FITNESS & HEALTH
®
1-800-432-5378
www.medicalert.org/caremore
Identify yourself as a CareMore Member to
receive the discounts.
An international charity, MedicAlert
Foundation® was established in 1956 and
pioneered the use of medical identification and
information services for medical emergencies.
We protect the health and well-being of more
than 4 million members worldwide through our
trusted 24/7 emergency support network. We
educate emergency responders and health
professionals about the services we provide
during emergencies. And, we communicate
your health information, your wishes, and your
directives to ensure you receive the best care
possible.
MedicAlert® members include the following
services and benefits for CareMore Members:
Live 24/7 Emergency Response Service
Comprehensive Emergency Medical
Information Record® (EMIR)
Free Emergency Wallet Card
Ongoing training of Emergency Responders
and Health Professionals
Advance Directives/DNR/Document Storage
Medic Alert + Alzheimer’s Association Safe
Return® $55 per year
Medic Alert Advantage $50 per year
(A premium offering)
MedicAlert EssentialTM $30 for 3 years
(An online platform)
https://www.choosehealthy.com/
default.aspx?hp=wellpnt
ChooseHealthy is your online partner for wellness
and health. We’re committed to providing you
with the very best online information, products
and resources to support your health goals. Save
on Fitness Facility memberships, health and
wellness products, visits to massage therapists,
acupuncturists and more.
Fitness Facility Memberships
Health & Wellness products
Massage therapists
Acupuncturists
The ChooseHealthy programs is a product of American
Specialty Health Fitness, Inc., a subsidiary of American
Specialty Health Incorporated (ASH). ChooseHealthy and
the ChooseHealthy logo are registered trademarks of ASH.
1-800-294-1500
www.globalfit.com/caremore
For more than 20 years, GlobalFit has been
committed to improving health through physical
activity. Save on fitness and gyms nationwide.
Join your choice of OVER 10,000 fitness
centers nationwide—including Curves, Bally’s,
Gold’s, Anytime Fitness, and many more—all at
the lowest available rate!
53
53
1-877-Jenny70
1-800-651-6000
www.jennycraig.com/orgcode=caremore
http://www.weightwatchers.com/cs/index.
aspx?path=cs/anthem
Get healthy with Jenny Craig and CareMore
Jenny Craig clients lose three times more weight
than dieting on their own.* Your consultant will
help you find the program that fits your life. Plus,
they’ll work with you to create a menu of delicious,
nutritionally-balanced meals to help you keep
feeling full and satisfied every step of the way!
*Rock CL, Flatt SW, Karanja N, et al. JAMA.
2010;304(16): 1803-1811. Clients following our
program, on average, lose 1-2 lbs per week.
As a CareMore member, you can choose one of
these discounted offers:
Jenny As You Go! $39/month-to-month.
FREE 30-Day Program**
or
Jenny All Access Membership**
$19.99/month-to-month (after 12 months,
monthly dues drops to $14.99). 30% discount
off a one time initial fee.
Visit www.jennycraig.com/orgcode=caremore
to register and unlock your discounts.
**Plus the cost of food. Plus the cost of shipping, if
applicable. Valid at participating centres. No cash
value. One offer per person. Not valid with any other
program offers or discounts. Restrictions apply.
Weight Watchers works. And it can work for
you! For over 50 years, we’ve helped millions
of people lose weight. Why does Weight
Watchers work for such wonderfully diverse
people? Easy: real food, combined with
a realistic (and entirely liveable) approach,
means anyone can lose weight.
$10 off a 3 month subscription to Weight
Watchers Online
Weight Watchers Online for only $55
(less than $5 per week)
1-888-686-8723
http://www.murad.com/special-offershealthplan-members
Murad’s transforming skincare products are at
the heart of a comprehensive approach that Dr.
Murad calls Inclusive Health. Transform your skin
and save!
$25 off plus FREE gift with any purchase of
$100 or more
Use promo code MuradSpecial to receive a
special offer
54
54
1-800-645-1030
http://www.puritan.com/sports-nutrition043?scid=19299&cm_mmc=Empire-_FitnessandHealth_-September-_-20PFS
It’s Puritan’s Pride mission to make the finest quality nutritional supplements available at the best
value. You’ll find variety and value in the pages of the Puritan’s Pride catalog. Join our six million
customers and see how Puritan’s Pride is the #1 way to shop at home for vitamin products and herbal
supplements.
20% on your order
Free Shipping on orders of $25 or more
DENTAL
1-855-887-7699
www.careington.com/co/caremore
Savings on dental care made easy!
Are you looking for savings on dental care? Try the Careington Dental Plan. This non-insurance plan allows
members to save 5% to 60% on most dental procedures including exams, X-rays, cleaning and major work
such as dentures, braces, root canals and crowns. Plus, you’ll have access to over 200,000 dental access
points which means more dentists for you to choose from! Do you want even better news? Anyone can join
the plan, there’s no waiting and it’s free to try for 30 days! Simply join the plan, visit a participating dentist in the
Careington dental network and receive the discount off the regular priced fee. It is that easy!
Plan starting at $6.75 a month or $67.95 for the year*.
* Plus a one-time, $5.00 non-refundable processing fee.
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable
coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act.
THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN.* The plan provides discounts at certain health care providers for medical
services. The range of discounts will vary depending on the type of provider and service. The plan does not make payments directly to the
providers of medical services. Plan members are obligated to pay for all health care services but will receive a discount from those health
care providers who have contracted with the discount medical plan organization. You may access a list of participating health care providers at
www.careington.com/co/caremore. Upon request the plan will make available a written list of participating health care providers. You have the
right to cancel within the first 30 days after receipt of membership materials and receive a full refund, less a nominal processing fee (nominal
fee for MD residents is $5, AR and TN resident will be refunded processing fee). Discount Medical Plan Organization and administrator:
Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.
This plan is not available in Montana and Vermont. This plan is not currently available in Washington. *Medicare statement applies to MD
residents when pharmacy discounts are part of plan.
55
55
1-800-373-5400
http://luminahealthcare.com
Lumina HealthCare is proud to be chosen by CareMore as a value-added service offered to all
CareMore Touch members, providing convenient, on-site dental care, right in the comfort of your own
home or place of residence. We provide complete mobile onsite dental services to members residing
in Skilled Nursing Facilities and Assisted Living Communities, board and care homes, or home-bound
members.
Health visits — $150 first visit
Initial evaluation, X-rays — $195
*Only offered in the following California counties: Los Angeles and Orange
HEARING
1-866-344-7756
http://hearingcaresolutions.com/
caremoremember/
Left untreated, hearing loss hinders
communication and ultimately diminishes
social interaction & quality of life. Hearing
Care Solutions simplifies care by offering
fixed discounted prices on digital
hearing aids.
Premium - $1,500 (Retail $4,200)
Advanced - $1,100 (Retail $2,800)
Superior - $800 (Retail $1,800)
Annual hearing exam at no charge for all
Medicare-eligible members
National Network
Several major manufacturers to choose from
One-year supply of batteries
1-800-675-5485
www.connecthearing.com
Connect Hearing is one of the largest networks
of hearing health care centers in the US. We
offer exceptional hearing care with locations
nationwide to serve you. Our Hearing Care
Professionals are highly educated and practice
the philosophy that the most successful hearing
aid solutions must fit precisely within your
lifestyle and everyday communication needs.
30% discount off Connect Hearing list price
on hearing aids
Free Hearing Evaluation
Price Match Guarantee
3 years of free batteries with hearing aid
purchase
3 year warranty and 3 year loss & damage
Visit us at connecthearing.com for more details.
56
56
MEDICAL & WELLNESS SUPPLIES
1-888-737-2055
www.acadderson.com/caremore
We are a medical products distributor dedicated
to providing the finest quality products available
at competitive prices.
Receive between a 10% - 30% Discount
Incontinence Supplies
Aids to Daily Living
Bath Safety Items
Mobility Products
Personal Hygiene
Skin Care Products
Bed and Accessories
Orthopedics
1-800-522-1448
www.natallergy.com/caremore
National Allergy™ is pleased to offer you a 15%
discount on every purchase you make with us!
Allergies and asthma getting the better of you?
Need more than tissues to get relief? Then it’s
time to take advantage of the discount offered by
National Allergy Supply.
As a CareMore member, you’re eligible to receive
a 15-percent discount off the already discounted
prices for our non-drug products including pillow
and mattress encasings, air filtration products,
sinus relief products, asthma compressors &
nebulizers and personal care products.
Receive 15% discount on every purchase.
Just enter or mention promotional code MEMBER15
when ordering to apply your discount.
1-800-255-3749
www.allergycontrol.com/caremore
Allergy Control Products’ goal is to help make
allergy sufferers’ homes and lifestyles healthier
and more manageable. Receive discounts on
allergy products for physician-recommended
products for relief from allergies, asthma,
sinusitis, sensitive skin and more:
Save 25% on allergy Control Pillow &
Mattress Encasings
Plus, save 20% on a wide range of these
products, including:
Hypo-allergenic bedding
Allergen-removing laundry & carpet products
Air filters
Sinus rinses and sinus care
Hypo-allergenic personal care products
Humidity and mold reducers
Just enter or mention promotional code VPWELL when
ordering to apply your discount!
57
57
VISION
1-888-811-3161
1-800-452-7737
www.enhancedvision.com
www.glasses.com
Low vision assistive technology enables
people to read, write and fully participate in life.
Enhanced Vision has the most comprehensive
line of easy-to-use and affordable low vision
products from simple digital magnifiers to
advanced video magnification systems with
HD and text-to-speech (OCR). Select from
products that provide you with portability,
distance viewing or just reading at home.
Glasses.com has the latest, brand-name
frames for just a fraction of the cost of typical
retailers, every day. As your personal glasses
stylist, our job is to help you find the glasses
you love and we’ve come up with some fun
ways to find the perfect pair, like our free inhome try-on and our 3D virtual try-on app.
We promise you’ll be delighted with your
experience and if you aren’t we’ll make it right.
100% satisfaction guaranteed. Every time.
Receive 10% off on all products.
$20 off orders over $100
Free shipping and free returns
100% satisfaction guaranteed
1-800-266-8228
www.1800contacts.com
1-800 CONTACTS, is the largest retailer of contact lenses in the United States, and is dedicated to
providing you with an easy, hassle-free way to purchase contact lenses. At 1-800 CONTACTS, you will
receive the exact same contact lenses your doctor prescribed, delivered to your door, at a great price.
$20 off orders over $100
Free shipping and free returns
100% satisfaction guaranteed
58
58
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health
Plan depends on contract renewal. This information is available for free in other languages. Please contact our
customer service number at 1-800-499-2793, TDD/TTY users call 711. 8 a.m. - 8 p.m., seven days a week
(October 1 through February 14, except Thanksgiving and Christmas) and Monday through Friday (except
holidays) from February 15 through September 30.
Esta información esta disponible gratis en otros idiomas. Por favor comuníquese con el departamento de
servicios al cliente al 1-800-499-2793, TDD/TTY deben llamar al 711, de 8 a.m. a 8 p.m., los 7 días de la
semana desde el 1 de octubre hasta el 14 de febrero (excepto el Día de Acción de Gracias y Navidad), y de
lunes a viernes (excepto los días feriados) desde el 15 de febrero hasta el 30 de septiembre.
59
59
Speak Up. Take Action.
Report Suspected Fraud, Waste and Abuse!
When it comes to your personal identity and health care benefits, you have the right to speak
up and take action if you sense something is not right. CareMore is committed to preventing
fraud, waste and abuse in the Medicare Advantage and prescription drug programs.
I’ve heard about Medicare fraud in
the news. What do I need to know?
Fraud is generally defined as making a false claim in order
to receive payment. Here are a few examples of fraud,
waste and abuse:
•
•
•
•
•
Billing for medical services that were never performed.
Billing for more care than is needed.
Misrepresenting type of treatment, service or diagnosis.
Using someone else’s identity to receive benefits.
Enrolling applicants in a plan without their knowledge
or consent.
• Billing for non-covered prescriptions as covered items.
To protect yourself from suspicious activities, always
thoroughly review your Explanation of Benefits (EOB) after
you receive health care services. If you see something
that doesn’t look right, you should call us right away. We
are here for you when you need us most!
How can I protect my identity and
Medicare benefits?
• Never give out your Social Security, Medicare or health
plan numbers or banking information to someone you
don’t know.
• Carefully review your health plan statements to ensure
all the information is correct.
What should I watch out for?
Be on the lookout for fraudulent schemes such as these:
• People calling you or coming to your home uninvited
(such as door-to-door sales people) to sell you
Medicare or health care items and services. (If the
caller says he/she is calling on behalf of your health
plan, we encourage you to call our toll-free number on
the back of your member ID card to verify the program
is a health plan-sponsored program.)
• People from non-contracted businesses that are
not authorized by your plan calling you on your
plan’s behalf. However, you may also get calls from
businesses contracted by your plan to call you about
health and plan-related topics. (If the caller says
he/she is calling on behalf of your health plan, and
you would like to confirm the topic is a health plansponsored program, please call our toll-free Member
Services number. Only give your information to doctors,
other providers and your health plan.)
• People from unknown businesses calling you to ask for
your Social Security, Medicare or health plan numbers.
(If the caller says he/she is calling on behalf of your
health plan, and you would like to confirm the topic is a
health plan-sponsored program please call our toll-free
Member Services number. Only give your information to
doctors, other providers and your health plan.)
• Know that free services do not require you to give your
plan or Medicare number to anyone.
• Share this information with your family members and
friends.
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health Plan depends on
contract renewal.
FWACMW14_EN
CHP Int.091308A (09/13)
60
60
• People offering you money or other incentives for
health care services, your Medicare ID card information
or to enroll in Medicare plans.
If anything like this happens to me,
what should I do?
• People calling you to offer free health care services.
However, keep in mind you may get a call about a valid
health plan-sponsored program that offers free health
care services. (If the caller says he/she is from your
health plan, and you would like to confirm the topic is a
health plan-sponsored program, we encourage you to
call our toll-free Member Services number to verify the
program is a health plan-sponsored program.)
• If you think you are a victim of, or see, potential
fraud, waste or abuse, please report it to our toll-free
Medicare Fraud Hotline immediately by calling 1-866847-8247, 24 hours a day, seven days a week. TTY/
TDD users may call 711.
• People using your Medicare or health plan member
number to get money back (reimbursed) for services
you never received.
• If you have concerns about a person who may have
called you saying that he or she is calling on behalf of
your health plan, or if you have questions about fraud,
waste and abuse – please call Member Services.
• People trying to bribe you to use a doctor you don’t
know to get health care services you may not need.
How would I know if there has been
fraudulent billing?
When you get your health plan statement or Explanation
of Benefits for services you received, always review it
thoroughly. You’ll want to make sure that the provider billed
for the services or items you actually received. Also, check
for duplicate billing or billing errors. And, if you receive a
package for medical supplies you did not order, refuse the
package. You should report companies that send you these
items.
CareMore Health Plan is an HMO/HMO SNP plan with a Medicare contract. Enrollment in CareMore Health Plan depends on
contract renewal.
FWACMW14_EN
CHP Int.091308A (09/13)
NOTES
61
+

HOW TO Guide

Transcription

Similar documents

CareMore Corporate Brochure

PROVIDER MANUAL 2015 Arizona California Nevada

cal mediconnect plan provider manual

Evidence of Coverage CareMore Touch (HMO SNP) Offered by

March - GeorgiaCares

November 2O14 - United American Insurance Company

Time: 6:00 to 8:00 PM Where: Shakey`s Pizza Parlor 12540 Valley

Maximizing Optometry Practice Revenue through Accurate Coding

Presentation - California Health Advocates

Senior Voices - ADRC of Northwest Wisconsin

Smile. The future looks good. - LTCI Partners. Planning Made Easy.

JPS HEALTH NETWORK • 537 bed hospital, Level 1 Trauma Center

Reference Guide for Excellus 2016