Member Handbook Effective as of May 1, 2007

Member
Handbook
Effective as of
May 1, 2007
Eligibility
Welcome to
Genesee Health Plan
Plan A
Table of Contents
Eligibility
Questions or Concerns
1
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mihealth Card
Enrollment Card
Enrollment
Choosing a Doctor
Covered Services
Not Covered
2
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Coverage Chart
3
The Genesee County Michigan
Department of Human Services
(formerly known as the Genesee
County Family Independence Agency),
or Department of Human Services,
determines if you are eligible for the
Adult Benefits Waiver (ABW) or Genesee
Health Plan. Please tell your caseworker
if you change jobs. You should also tell
your caseworker if you move or get
other insurance. Call your Department
of Human Services caseworker if you
have questions about your eligibility. If
your eligibility with ABW is denied, call
your Department of Human Services
caseworker.
Questions or Concerns
Genesee Health Plan (GHP) is a
community-sponsored program
for eligible residents in Genesee
County. This is not insurance.
Genesee Health Plan provides
limited coverage for doctor
visits, prescriptions, lab tests and
x-rays. You will be responsible
for payment if you receive services that are not covered.
This booklet will help you learn
how to make the most of your
enrollment in Genesee Health
Plan. Please take the time to read
it.
If you have questions, please
call (810) 720-7785 or 1-800
854-7563, 24 hours, seven days
a week and ask for Genesee
Health Plan. These are local or
free numbers. We will be happy
to help you.
Family Planning
4
Emergency Services
4
Mental Health and Substance Abuse Services 4
Mental Health Medications
4
Prescription Services
4
Transportation
4
Disease Management
4
Services Outside of Genesee County
4
Hospital
4
Breast and Cervical Cancer Screening
Federally Qualified Health Clinics
Bills
Take Care of Yourself
Disenrollment from Genesee Health Plan
Request for Disenrollment
Fraud
Grievance Process
5
5
5
5
5
5
5
5
Rights and Responsibilities
Statement of Confidentiality
Privacy Statement
6
6
6
Glossary of Terms
7
Genesee Health Plan has asked
HealthPlus Options to act as
administrator for this program. The
administrator pays claims at the
direction of Genesee Health Plan. The
administrator also assists with changing
doctors, answering your questions and
other tasks.
We want to help you get the most out
of Genesee Health Plan. If any of the
following should happen, call Genesee
Health Plan at (810) 720-7785 or 1-800854-7563, 24 hours, seven days a week.
These are local or free numbers.
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Address change
Request to change your PCP
Other health treatment coverage
Lost or stolen enrollment card
If you receive a bill
Quality of treatment concerns
Questions about Genesee Health Plan
If you need a list of providers
If you have special needs and need
written materials in alternative formats
Other numbers:
• Outside of Genesee County
1-800-854-7563, 24 hours, seven days a
week (toll-free)
• Telecommunications Device for the
Deaf (TDD) 1-800-992-5070 (toll-free)
Visit us: Genesee Health Plan
G-3169 Beecher Rd., Suite 104 Flint, MI 48531
Write us: Genesee Health Plan
C/O HealthPlus Options
PO Box 1700
Flint, MI 48501-1700
1
mihealth Card
You will receive a green and blue
MIHEALTH card from the Michigan
Department of Community Health once
you are eligible for Genesee Health
Plan. DO NOT THROW THIS CARD AWAY.
You will need this card to get other
services that Genesee Health Plan does
not pay for. These services include
certain prescriptions, substance abuse
and mental health services. Please call
the Beneficiary Helpline if you do not
receive a MIHEALTH card or if you lose
your card. The number to call is
1-800-642-3195.
Enrollment Card
You will receive a Genesee Health Plan
enrollment card within 10 business days.
If you do not receive a card, the numbers
to call are (810) 720-7785 or 1-800-8547563. These are local or free numbers.
You will need to show identification
when you use your enrollment card to
receive health care services. A Michigan
Identification Card or driver’s license will
do. Only the person listed on the card
may use it to receive services. Keep it
with you at all times. Please call
(810) 720-7785 if you lose your Genesee
Health Plan card.
Enrollment
You will be enrolled in Genesee Health
Plan after you have been found eligible
for ABW services by the Department of
Human Services. Your start date with
Genesee Health Plan will be one to two
months after your eligibility date. If you
do not choose a Primary Care Physician
(PCP), Genesee Health Plan will pick
one for you and notify you by mail. The
name of the PCP and the PCP telephone
number will appear on your enrollment
card. You may change your PCP for any
reason by calling (810) 720-7785. The
change will be effective the first day of
the month after you make your request.
2
Choosing a Doctor
Covered Services
You must see a Genesee Health Plan
doctor or PCP for your health services.
Please call (810) 720-7785 to choose a
doctor from the provider list. If you do
not choose a PCP, Genesee Health Plan
will choose one for you and notify you
by mail. You may change your PCP for
any reason. The change will be effective
on the first day of the month after you
make your request. We will be happy
to work with you to find a doctor if you
have special issues or concerns. Your
care may require that a specialist serve
as your PCP. Talk to your PCP or call
(810) 720-7785 if you think you need a
specialist to help manage your care. Call
Genesee Health Plan if you currently
have a PCP or doctor who accepts
Genesee Health Plan. We will work to
keep you with your current PCP.
Covered services must be provided
by your PCP or a provider who has a
contract with Genesee Health Plan. If
necessary, your PCP may refer you to a
provider who does not have a contract.
You will have to pay for services if you
don’t get a referral from your PCP. See
the list of covered services in the chart
on the next page. The list is a summary.
This does not mean that all related
services will be covered.
Your doctor will arrange for your care,
including referrals to a specialist, x-rays
or prescriptions.
Call for an appointment if you need to
see your doctor. The doctor’s telephone
number is on your enrollment card.
When you call your doctor, tell him or
her the reason you need to be seen.
The doctor’s assistant may give you
an appointment. He or she also may
suggest that you try something at home
or go to a specialist.
Be ready for your appointment with the
doctor:
• Write down how you are feeling
• Write down any questions you want to
ask
• Write down the names of any
medicines you are taking
• Ask questions if you don’t understand
your doctor’s directions for your care,
your medication, etc.
Please call your doctor the day before
if you need to change or cancel an
appointment. This allows your doctor to
see someone else who may need help.
You should go to an emergency room
or call 911 if you have a life-threatening
emergency.
Not Covered
Genesee Health Plan does not cover the
following services. Payment will not be
made for:
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Oxygen or oxygen supplies
Inpatient hospital services
Case management
Custodial or nursing home care
Chiropractic services
Experimental procedures, treatments
or drugs
Comfort or convenience items
Prosthetics and orthotics, corrective
shoes or wigs
Speech, physical or occupational
therapy
Urgent care clinics–facility charges
Private duty nurses
Hearing aids
Weight reduction services or programs
(non surgical weight reduction
services)
Services considered to be cosmetic
(those not considered a medical
necessity)
Home health services or personal care
Hospice care
Services or supplies related to sex or
gender change
Vision exams, eyeglasses or contact
lenses (exams by referral related to
chronic illness are covered)
Podiatry services (exams by referral
due to chronic illness are covered)
Dental services
Smoking cessation programs
Transportation (non-ambulance)
Emergency transportation by air
Any condition for which an enrollee is
eligible to receive health care services
or benefits through a public or private
benefit, program or insurance
Coverage for Genesee Health Plan
Plan A
Service
Allergy Testing
Ambulance
Case Management
Chiropractor
Dental
Dermatology
Emergency Services
Eyeglasses
Family Planning
• Contraceptive devices (limited
to one per year)
• Infertility screening
Hearing Aids
Home Health
Home Help (personal care)
Hospice
Immunizations
Inpatient Hospital
Lab & X-Ray
• Diagnostic and therapeutic
EKG, x-ray, radium isotope
and radiation therapy
• CAT, MRI, MRA and PET
• Chelation therapy for certain
diagnoses
Medical Supplies/Durable
Medical Equipment (DME)
Mental Health Services
Nursing Facility
Optometrist
Outpatient Hospital (not
emergency services)
• Surgery
• Dialysis
• Chemotherapy
• Sterilization
• Radiation
Pharmacy
Physician
Nurse Practitioner (NP)
Oral Surgeon
Medical Clinic
Specialist
Podiatrist
Prosthetics/Orthotics
Private Duty Nursing
Substance Abuse
Therapies
Transportation (non
ambulance)
Urgent Care Clinic
Coverage
Allergy extract and extract injection
Limited to emergency ground ambulance transport to the hospital emergency
room
Not covered
Not covered
Routine dental services are not covered except for services of oral surgeons.
Covered if ordered by an MD, DO or NP
Covered
Not covered
Covered
Infertility treatment is not covered.
Not covered
Not covered
Not covered
Not covered
Covered per ACIP guidelines. Travel immunizations are not covered.
Not covered
Covered if ordered by an MD, DO or NP for diagnostic and treatment
purposes.
Copay
N/A (not applicable)
N/A
N/A
N/A
N/A
$0 Copay
$0 Copay
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Limited coverage. Medical supplies are covered except for the following:
• Gradient surgical garments, formulas and feeding supplies, and supplies related
to any noncovered DME item.
• DME items are not covered except for glucose monitors
• Oxygen or oxygen supplies are not covered
No copays for diabetic
supplies
Covered. Services including psychotropic medication and injectables must be
provided through the local community mental health center.
Not covered
Not covered
Covered
• Diagnostic and treatment services
• Diabetes education services with a valid referal
N/A
Covered
• Mental health prescriptions covered under the FFS benefit using the MIHEALTH
card
• Not covered: Injectables used in clinics or physician offices.
• Office visits
• Annual physical exams (including a pelvic and breast exam and Pap test).
Women who qualify for screening/services under breast and cervical cancer
programs administered by the local health department may be referred to that
program for services as appropriate.
• Diagnostic and treatment services. May refer to local health department for TB,
STD or HIV-related services, as available and appropriate.
• General ophthalmologic services (procedure codes 92002-92014).
• Immunizations per ACIP guidelines. May be referred to the local health
department. Travel immunizations are excluded.
• Injections administered in a physician’s office per current Medicaid policy.
Limited services
• When referred by a primary care physician for foot care related to diabetes.
Diagnosis codes 250.00-250.93 with procedure codes G0247 and G0246.
• When referred by a primary care physician for foot care related to vascular
insufficiency. Diagnosis codes 355.7-355.8 for procedure codes G0247
and G0246.
Not covered
Not covered
Covered through local Mental Health/Substance Abuse programs.
Occupational, physical and speech therapy evaluations are covered when
provided by physicians or in the outpatient hospital setting. Therapy services
are not covered in any setting.
Not covered
Professional services provided in a freestanding facility are covered.
N/A
N/A
$0 Copay
$1 copay. No copays for
diabetic drugs or supplies
$0 Copay
$0 Copay
N/A
N/A
N/A
N/A
N/A
$3 copay
3
Not Covered continued
• Lodging expenses
• Office visits, exams, treatments or tests
related to documentation of health
for employment, insurance, marriage
license, school, sports physicals,
citizenship or any legal proceeding or
court-mandated activity
• Services received before the effective
date of coverage or after the
termination of enrollment
• Over-the-counter medicines without a
prescription or supplies such as first aid
materials or vitamins
• Services not approved by the Genesee
Health Plan doctor on your enrollment
card or a specialist you are referred to
• Services that are not medically
necessary
• Immunizations required for travel
• Maternity or obstetrical services
*You should contact the Genesee
County Michigan Department of Human
Services office (formerly known as the
Genesee County Family Independence
Agency) or Department of Human
Services if you become pregnant while
a member of Genesee Health Plan. Ask
about Medicaid eligibility as soon as
possible. Remember to avoid drugs
and alcohol if you think you could be
pregnant.
Family Planning
Genesee Health Plan will pay for any fees
when you receive services from a local
family planning agency. You do not need
a referral to receive services from a local
family planning agency.
Call or visit the Genesee Health
Department at (810) 257-3612 or
Planned Parenthood at (810) 234-1659
for family planning services.
Emergency Services
Emergency services are covered
for medical emergencies. Medical
emergencies include things like chest
pain, serious wounds or accidental
injuries. Prior authorization may be
required for non-emergency services
provided in the emergency department.
Colds, headaches and back pain are not
considered emergencies. Please see your
PCP during regular business hours for
these conditions.
4
Mental Health and Substance
Abuse Services
Genesee Health Plan does not cover
mental health or substance abuse
services. Please contact Genesee County
Community Mental Health at (810)
257-3742 or 1-877-346-3648 if you need
mental health services. These are local
or free numbers. Call Intake Assessment
and Referral Center (IARC) at (810)
235-9555 if you need substance abuse
services. This is a local call.
Your MIHEALTH card will cover mental
health or substance abuse services.
Mental Health Medications
Genesee Health Plan does not cover
mental health prescriptions. If you need
mental health prescriptions, please
contact Genesee County Community
Mental Health at (810) 257-3742 or
1-877-346-3648. These are local or free
numbers.
Your MIHEALTH card will cover mental
health prescriptions.
Prescription Services
Prescriptions must be written by an
approved Genesee Health Plan PCP or
specialist. Your PCP has a list of drugs
that Genesee Health Plan recommends.
The list has many drugs for your doctor
to choose from. Genesee Health Plan
works with many pharmacies in Genesee
County. Please call Genesee Health Plan
at (810) 720-7785 if your pharmacy does
not work with Genesee Health Plan.
Please call Genesee Health Plan at the
number listed above if you have trouble
getting a prescription filled.
A prescription coordinator may help
you with medicine that is not covered
by Genesee Health Plan. Please
call Genesee Health Plan at (810)
720-7785. Mental health drugs are
covered through the Genesee County
Community Mental Health at (810) 2573742 or 1-877-346-3648. These are local
or free numbers.
You can get your prescriptions
filled in Genesee County by almost
any pharmacy. If you need a list of
pharmacies, please contact Genesee
Health Plan at 1-800-854-7563. A list will
be mailed to you.
Transportation
Call 911 if you decide that your medical
problem is serious and you need
transportation to the emergency room.
Genesee Health Plan covers emergency
transportation to the emergency room.
Genesee Health Plan does not cover
non-emergency transportation.
Disease Management
Genesee Health Plan believes it is
important to stay healthy. Please tell
your doctor to call (810) 232-7740 to
find out if Genesee Health Plan can help
you stay healthy if you have diabetes or
a heart condition. We can work with your
doctor to help you.
Services Outside of Genesee
County
If you are outside of Genesee Health
Plan’s service area and you are sick,
please call your doctor’s telephone
number. He or she will help you decide
what to do.
You may have to pay the bill if you get
non-emergency services outside the
service area without authorization.
Do not use the emergency room or
after hours center for illness that can
be treated by your doctor during office
hours.
Call your PCP if you are sick. Go to the
nearest emergency room or call 911 if
you have a life threatening condition.
Hospital
Inpatient hospital services are not
covered by Genesee Health Plan. If you
need inpatient care, contact your caseworker at the Genesee County Michigan
Department of Human Services
(formerly known as the Genesee
County Family Independence Agency)
or Department of Human Services. You
also may be asked to apply for Medicaid.
Medicaid will pay for your inpatient care
if you are eligible. You will no longer be
eligible for Genesee Health Plan or the
Adult Benefits Waiver program if you are
eligible for Medicaid.
Breast and Cervical Cancer
Screening
Screening services, including Pap tests,
pelvic exams, clinical breast exams
and mammograms are available to
all women in Genesee Health Plan.
Community programs are also available
to women 40 years of age and older.
Call the Breast and Cervical Cancer
Screening program at (810) 237-4545
for information about receiving these
services. Genesee Health Plan will
pay for any fees charged when you
are referred to a local family planning
agency.
Federally Qualified Health Clinics
Genesee Health Plan contracts with
Hamilton Community Health Center. This
means you can choose to have Hamilton
Community Health Center as your PCP.
Please call (810) 720-7785 if you want
to choose Hamilton Community Health
Center as your PCP. We will be happy to
work with you to find a doctor if there
are special issues or concerns, or if you
want to change your PCP.
Bills
You will need to show your Genesee
Health Plan card to receive any covered
service. You should not be billed for
any covered services approved by your
doctor and provided by a Genesee
Health Plan provider. If you do receive
a bill, DO NOT THROW IT AWAY. DO NOT
PAY IT. Call us at (810) 720-7785. You
will be responsible for payment in the
following cases:
• if you get services that your Genesee
Health Plan doctor has NOT authorized
• if you receive services that are not
covered by Genesee Health Plan
• if you choose to receive services that
are not medically necessary
Take Care of Yourself
You can do lots of things to stay healthy
and lower your chances of becoming
ill. Eat right, get plenty of exercise and
control your stress. If you smoke, STOP.
Say NO to drugs and alcohol. Practice
safety.
Substance Abuse – you may have a drug
or alcohol problem if you:
Request for Disenrollment
• Drink or take drugs every day
• Lie about drinking and using drugs
• Have money problems because of
drugs and drinking
• Hurt yourself or others when drinking
or using drugs
• Drink or take drugs to “feel better”
If this sounds like you, you can talk
to your doctor or local mental health
agency at (810) 257-3742 or
1-877-346-3648 or a local substance
abuse agency at (810) 235-9555. These
are local or free calls.
Genesee Health Plan may request that
Michigan Department of Community
Health disenroll you if:
Disenrollment from Genesee
Health Plan
Other Insurance
You will not be eligible for enrollment
in Genesee Health Plan or the Adult
Benefits Waiver program if you become
eligible for any kind of medical
insurance. Please notify the Genesee
County Michigan Department of Human
Services office (formerly known as the
Genesee County Family Independence
Agency) or Department of Human
Services for assistance at (810) 7602200 if you get other medical insurance
coverage.
Moving out of Genesee County
You will not be eligible for enrollment
in Genesee Health Plan if you move out
of Genesee County. You may be eligible
for the Adult Benefits Waiver program
in the new county. Contact the Genesee
County Michigan Department of Human
Services office (formerly known as the
Genesee County Family Independence
Agency) or Department of Human
Services for assistance at (810) 760-2200.
This is a local number.
Change of Income
Please notify your Genesee County
Michigan Department of Human
Services office (formerly known as the
Genesee County Family Independence
Agency) or Department of Human
Services caseworker of any change in
your income or circumstances. The
number to call is (810) 760-2200. This is
a local number.
1. You let someone else use your
Genesee Health Plan enrollment card
for services.
2. You cannot maintain a good
relationship with your PCP. Examples
of a bad relationship with your doctor
are:
a. Refusing to follow the PCP’s advice
b. Continually going to an emergency
room for non-emergency care
c. Going to a provider who is not with
Genesee Health Plan without your
PCP’s okay
d. Acts of fraud
e. Threats, life threatening or
otherwise
Genesee Health Plan will talk to you
when these things happen. We will only
ask that you be disenrolled if we can’t
solve the problem. If you do not agree
with us, you may start a grievance by
calling Genesee Health Plan at
(810) 720-7785.
Fraud
You may lose your eligibility and be
subject to legal action if you commit a
fraudulent act against Genesee Health
Plan and/or the Adult Benefits Waiver.
Fraud can mean lying to get a benefit
that is not in your contract.
Grievance Process
Please call us at (810) 720-7785 if you
have a question or concern about
Genesee Health Plan. You may file a
grievance if you disagree with Genesee
Health Plan’s decision to deny a service.
We will try our best to answer your
questions and resolve any issues.
However, if you are not satisfied with
the response, you have a right to make
a formal grievance. You may file a
grievance by:
1.Calling (810) 720-7785 or writing to
Genesee Health Plan
P.O. Box 1700
Flint, Michigan 48501-1700
2.We will respond to your grievance
within 15 days of receiving your call
or letter. You will receive a written
response stating the decision.
5
3.If you are not satisfied with the
decision, you may request an appeal.
4.You may also request an Administrative
Hearing from the Michigan
Department of Community Health. You
can file a grievance with the Michigan
Department of Community Health
without using Genesee Health Plan’s
grievance process. You must file your
grievance in writing. The address is:
Administrative Tribunal and Appeals
Division
Michigan Department of Community
Health
P.O. Box 30195
Lansing, MI 48909
1-877-833-0870
Rights and Responsibilities
As an enrollee, you have the right to:
• Be treated with respect and dignity
• Receive quick and friendly service
• Be able to help make decisions about
your health care
• Be able to discuss treatment options
without regard to cost or coverage
• Have the right to refuse treatment and
be told of the possible impact of doing
so
• Be able to review your medical record
with your doctor
• Have confidential health records
except when disclosure is allowed by
law or approved in writing by you
• Be able to complain about Genesee
Health Plan or the services you
receive and to get a response to your
complaint
• Be treated and not discriminated
against on the basis of health needs or
health status
You have the responsibility:
• To treat Genesee Health Plan providers
and staff with respect
• To choose a doctor and keep
appointments
• To be honest when providing
information to providers
• To follow the advice of the provider
and to consider the impact if you
refuse to listen
• To express your complaints to Genesee
Health Plan or your doctor
6
Statement of Confidentiality
As a Genesee Health Plan enrollee, you
give your routine consent to release
personal data including the following:
name, address, plan identification
number, claims and referrals. This
information may be used to:
• Enroll you in the plan
• Arrange for your health care
• Pay claims
Privacy Statement
This notice describes how personal and
medical information about you may be
used and disclosed and how you can get
access to this information. Please review
it carefully.
Understanding the Type of
Information We Have
We get information about you when you
enroll in a health plan. It includes your
date of birth, sex, ID number and other
personal information. We also get bills,
reports from your doctor and other data
about your medical care.
Our Privacy Commitment To You
We care about your privacy. The
information we collect about you is
private. We are required to give you a
notice of our privacy practices. Only
people who have both the need and the
legal right may see your information.
We protect your privacy in oral, written
and electronic formats. Unless you give
us permission in writing, we will only
disclose your information for purposes
of treatment, payment, business
operations or when we are required
by law to do so. We will not sell any
information about you.
• Treatment–We may disclose medical
information about you to coordinate
your health care. For example, we may
notify your doctor about care you get
in an emergency room.
• Payment–We may use and disclose
information so the care you get can
be properly billed and paid for. For
example, we may ask an emergency
room for details before we pay the bill
for your care.
• Business Operations–We may need to
use and disclose information for our
business operations. For example, we
may use information to review the
quality of care you get.
• Health Related Benefits and Services–
We, or our agents, may contact you
about other health-related benefits
and services that may be of interest to
you.
•Exceptions–For certain kinds of records,
your permission may be needed even
for release for treatment, payment and
business operations.
• As Required By Law–We will release
information when we are required by
law to do so. Examples of such releases
would be for law enforcement or
national security purposes, subpoenas
or other court orders, public health
services, communicable disease
reporting, disaster relief, review of our
activities by government agencies,
to avert a serious threat to health or
safety or in other kinds of emergencies.
• With Your Permission–We may use and
disclose your personal information if
you give us permission in writing. You
have the right to change your mind
and take back your permission. This
must be in writing, too. We cannot take
back any disclosures made with your
permission.
Your Privacy Rights
You have the following rights regarding
the health information that we have
about you. Your requests must be made
in writing to Genesee Health Plan, P.O.
Box 1700, Flint, MI, 48501-1700.
• Your Right to Inspect and Copy–In
most cases, you have the right to look
at or get copies of your records. You
may be charged a fee for the cost of
copying your records.
• Your Right to Amend–You may ask us
to change your records if you feel that
there is a mistake. We can deny your
request for certain reasons, but we
must give you a written reason for our
denial.
• Your Right to a list of Disclosures–You
have the right to ask for a list of
disclosures made after April 14, 2003.
This list will not include the times
that information was disclosed for
treatment, payment or health care
operations. The list will not include
information provided directly to you
or your family, or information that was
sent without your authorization.
• Your Right to Request Restrictions on
Our Use or Disclosure of Information–
Your have the right to ask for limits
on how your information is used or
disclosed. We are not required to agree
to such requests.
• Your Right to Request Confidential
Communications–You have the right
to ask that we share information with
you in a certain way or in a certain
place. For example, you may ask us to
send information to your work address
instead of your home address. You do
not have to explain the basis for your
request.
• Other Laws and Regulations–Genesee
Health Plan must comply with all
federal and state laws and regulations.
Michigan law and other federal law
may provide additional protection for
your personal health information, such
as HIV/AIDS, behavioral health and
minors.
Changes to this Notice
We have the right to revise this notice.
A revised notice will be effective for
medical information we already have
about you. It will also be effective for
any information we may receive in the
future. We are required by law to comply
with whatever notice is currently in
effect. Any changes to our notice will be
published on our Web site. Go to
www.healthplus.org. You will receive a
copy in the mail of any new notice that
contains important changes.
How to Use Your Rights Under
This Notice
Call us or write to us if you want to use
your rights under this notice. We will
help you prepare a written request if
you are asked to submit your request in
writing.
Complaints and Communications to Us
If you want to:
• exercise your rights under this notice
• communicate with us about privacy
issues
• file a complaint
You may write to:
Privacy Officer
Genesee Health Plan
P.O. Box 1700
Flint, MI 40501-1700
(810) 720-7785
TDD for the deaf 1-800-992-5070
You will not be penalized for filing a
complaint.
Complaints to the Federal
Government
If you believe that your privacy rights
have been violated, you have the right
to file a complaint with the federal
government. You may write to:
Office of Civil Rights
Dept. of Health and HumanServices
200 Independence Avenue SW
Washington, DC 20201
Phone: 1-866-627-7748
TTY: 1-886-788-4989
E-mail: [email protected]
You will not be penalized for filing a
complaint with the federal government.
Copies of this Notice
You have the right to receive an
additional copy of this notice at any
time. Even if you have agreed to
receive this notice electronically, you
are still entitled to a paper copy of this
notice. Please call or write to us at the
address listed under “Complaints and
Communications to Us” to request a
copy.
Enrollee: A person who is a member of
Genesee Health Plan.
Enrollment Card (ID Card): A card
that you receive when you are enrolled
in Genesee Health Plan. The card lets
providers know you belong in Genesee
Health Plan.
Medical Emergency: See Emergency.
PCP: Primary Care Physician. Applies to
internists, family physicians and general
practitioners.
Prior Authorization: A medical service
that requires approval by Genesee
Health Plan before the enrollee may
receive it.
Referral: Permission from your PCP to
see another provider in the health plan
network.
Specialist: A physician (not your PCP)
who provides certain services that your
PCP does not provide. Some examples
of a specialist are dermatologist (skin
doctor), cardiologist (heart doctor) or
ophthalmologist (eye doctor).
Glossary of Terms
ABW: Adult Benefits Waiver. Program
administered by the State of Michigan.
Individuals enrolled in a Plan A program
are eligible with the Adult Benefits
Waiver program.
Provider: Refers to anyone providing
medical services. It usually means a
doctor.
Covered Services: Medical and supply
services provided through your Adult
Benefits Waiver program. This is paid for
by Genesee Health Plan.
Copay: The part of a medical expense
that you must pay for.
Emergency: A medical condition with
symptoms that come on quickly. Any
condition that could cause serious injury if you do not get immediate medical
attention.
Eligibility: When you qualify for coverage under the Adult Benefits Waiver
Program.
Enrollment: To be covered under
Genesee Health Plan. You will receive an
enrollment card after you are enrolled in
the plan. This means your medical and
pharmacy bills will be paid by Genesee
Health Plan.
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