Member Handbook Plan A Effective as of

Plan A
Member
Handbook
Effective as of
May 1, 2007
Eligibility
Welcome to
Bay Plan
Plan A
Table of Contents
Bay Health Plan (BHP) is a
community-sponsored program
for eligible residents in Bay
County. This is not insurance.
Bay Health Plan provides limited
coverage for doctor visits,
prescriptions, lab tests and xrays. 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 Bay Health Plan.
Please take the time to read it.
If you have questions, please
call (989) 797-7609 or 1-800854-7563, 24 hours, seven days
a week and ask for Bay Health
Plan. These are local or free
numbers. We will be happy to
help you.
Eligibility
Questions or Concerns
1
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mihealth Card
Enrollment Card
Enrollment
Choosing a Doctor
Covered Services
Not Covered
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Coverage Chart
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Family Planning
4
Emergency Services
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Mental Health and Substance Abuse Services 4
Mental Health Medications
4
Prescription Services
4
Transportation
4
Disease Management
4
Services Outside Bay County
4
Hospital
4
Breast and Cervical Cancer Screening
Federally Qualified Health Clinics
Bills
Take Care of Yourself
Disenrollment from Bay Health Plan
Request for Disenrollment
Fraud
Grievance Process
5
5
5
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5
5
Rights and Responsibilities
Statement of Confidentiality
Privacy Statement
6
6
6
Glossary of Terms
7
The Bay County Michigan Department
of Human Services (formerly known as
the Bay County Family Independence
Agency), or Department of Human
Services, determines if you are eligible for
the Adult Benefits Waiver (ABW) or Bay
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 Bay County
Michigan 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
Bay Health Plan has asked HealthPlus
Options to act as administrator for this
program. The administrator pays claims
at the direction of Bay 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
Bay Health Plan. If any of the following
should happen, call Bay Health Plan at
(989) 797-7609 or 1-800-854-7563. These
are local or free numbers. You can call 24
hours a day, seven days a week.
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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 Bay 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 Bay County
1-800-854-7563 (toll-free). You can call
24 hours a day, seven days a week.
• Telecommunications Device for the
Deaf (TDD) 1-800-992-5070 (toll-free)
Visit us: Bay Health Plan
1200 Washington
Bay City, MI 48708
Write us: Bay Health Plan
C/O HealthPlus Options
PO Box 1700
Flint, MI 48501-1700
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mihealth Card
You will receive a green and blue
MIHEALTH card from the Michigan
Department of Community Health once
you are eligible for Bay Health Plan. DO
NOT THROW THIS CARD AWAY. You will
need this card to get other services
that Bay Health Plan does not pay for.
These services could include certain
prescriptions or 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 Bay Health Plan
enrollment card within 10 business days.
Please call us at (989) 797-7609 or 1-800854-7563 if you do not receive a card.
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 (989)
797-7609 if you lose your Bay Health
Plan card.
Enrollment
You will be enrolled in Bay Health Plan
after Bay County Michigan Department
of Human Services determines that you
are eligible for ABW services. Your start
date with Bay Health Plan will be one to
two months after your eligibility date.
If you do not choose a Primary Care
Physician (PCP), Bay Health Plan will pick
one for you and notify you by mail. The
name of the PCP and PCP telephone
number will appear on your enrollment
card. You may change your PCP for any
reason. Just call (989) 797-7609. The
change will take place the first day of
the month after you make your request.
2
Choosing a Doctor
Covered Services
You must see a Bay Health Plan doctor or
PCP for your health services. Please call
(989) 797-7609 to choose a doctor from
the provider list. If you do not choose
a PCP, Bay 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 primary care doctor or call
(989) 797-7609 if you think you need a
specialist to help you manage your care.
Call Bay Health Plan if you currently have
a PCP or doctor who accepts Bay 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 to provide medical services
to Bay Health Plan. Your PCP may refer
you to a non-contracted provider when
necessary. You will be responsible for
payment if you go to a non-contracted
provider without a referral. See the
covered services listed in the chart on
the next page. The list is a summary. Not
all related services will be covered.
Your doctor will arrange for your care.
This includes referrals to a specialist,
x-rays and 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 about your
care, your medicine, etc.
Call your doctor the day before your
appointment if you need to change or
cancel your appointment. This allows
your doctor to see someone else who
may need help.
You should go directly to an emergency
room or call 911 if you have a lifethreatening emergency.
Not Covered
Bay Health Plan does not cover the
following services and 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
Lodging expenses
Service
Allergy Testing
Ambulance
Case Management
Chiropractor
Dermatology
Dental
Emergency Department
Eyeglasses
Family Planning
• Contraceptive devices (limited
to one per year)
• Infertility screening
Hearing Aids
Home Health
Home Help (personal care)
Hospice
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 (non
emergency department)
• 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 for Bay Health Plan
Plan A
Coverage
Allegy extract and extract injection
Limited to emergency ground ambulance transport to the hospital Emergency
room
Not covered
Not covered
Covered if ordered by an MD, DO or NP
Routine dental services are not covered except for services of oral surgeons.
Covered
Not covered
Covered
Infertility treatment is not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Covered if ordered by an MD, DO or NP for diagnostic and treatment
purposes.
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 and oxygen supplies are not covered
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 with a valid referral.
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.
Copay
N/A (not applicable)
N/A
N/A
N/A
$3 copay
N/A
$3 copay
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$3 copay
No copays for diabetic
supplies
N/A
N/A
N/A
N/A
$1 copay
$3 copay
$3 copay
N/A
N/A
N/A
N/A
N/A
$3 copay
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Not Covered continued
• 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 Bay
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 Bay County
Michigan Department of Human
Services office (formerly known as
the Bay County Family Independence
Agency or FIA) if you become pregnant
while a member of Bay Health Plan.
Ask about Medicaid eligibility as soon
as possible. Remember to avoid drugs
and alcohol if you think you might be
pregnant.
Family Planning
Bay Health Plan will pay for any fees
when you 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 Bay Health Department
at (989) 895-4015 for family planning
services.
Emergency Services
Emergency services are covered
for medical emergencies. Medical
emergencies are 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 go
to your primary care doctor’s office for
these conditions.
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Mental Health and Substance
Abuse Services
Bay Health Plan does not cover mental
health or substance abuse services.
Please contact Bay County Community
Mental Health if you need mental
health services. The numbers to call are
(989) 846-4521 or 1-800-258-8678. These
are local or free numbers. If you need
substance abuse services, please call
(989) 758-3781. This is a local call. Your
MIHEALTH card will cover mental health
or substance abuse services.
Mental Health Medications
Bay Health Plan does not cover mental
health prescriptions, if you need mental
health prescriptions. Please contact Bay
County Community Mental Health. The
number to call is (989) 846-4521. This is a
local call. Your MIHEALTH card will cover
mental health prescriptions.
Prescription Services
Prescriptions must be written by an
approved Bay Health Plan PCP or
specialist. Your PCP has a list of drugs
that Bay Health Plan recommends. The
list has many drugs for your doctor to
choose from. Bay Health Plan works with
many pharmacies in Bay County. Please
call Bay Health Plan at (989) 797-7609 if
your pharmacy does not work with Bay
Health Plan. Please call Bay 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 Bay
Health Plan. Please call Bay Health Plan
at (989) 797-7609. Mental health drugs
are covered through the Bay County
Community Mental Health at
(989) 846-4521 or 1-800-258-8678. These
are local or free numbers.
You can get your prescriptions filled in
Bay County by almost any pharmacy.
If you need a list of pharmacies, please
contact Bay 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.
Bay Health Plan covers emergency
transportation to the emergency room.
Bay Health Plan does not cover nonemergency transportation.
Disease Management
Bay Health Plan believes it is important
to stay healthy. Bay Health Plan can
work with your doctor to help you if
you have diabetes or a heart condition.
Please tell your doctor to call
(989) 755-3929 to find out if Bay Health
Plan can help you stay healthy.
Services Outside of Bay County
If you are outside of Bay 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. If
you get non-emergency services outside
the service area without authorization,
you may have to pay the bill. 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. If you have a life
threatening condition, go to the nearest
emergency room or call 911.
Hospital
Inpatient hospital services are not
covered by Bay Health Plan. If you need
inpatient care, contact your caseworker
at the Bay County Michigan Department
of Human Services (formerly known as
the Bay County Family Independence
Agency, or FIA.) 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 Bay
Health Plan or the Adult Benefits Waiver
program if you are eligible for Medicaid.
Breast and Cervical Cancer
Screening
Substance abuse – you may have a drug
or alcohol problem if you:
Screening services, including Pap tests,
pelvic exams, clinical breast exams
and mammograms are available to all
women in Bay Health Plan. Community
programs are available to women 40
years of age and older. Call the Breast
and Cervical Cancer Screening program
at (989) 895-4015 for information about
receiving these services. Bay Health Plan
will pay for any fees charged when you
are referred to a local family planning
agency.
• 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 (989) 846-4521 or
1-800-258-8678 or a local substance
abuse agency at (989) 758-3781. These
are local or free calls.
Federally Qualified Health Clinics
Bay Health Plan contracts with Health
Delivery, Inc. This means you can choose
to have Health Delivery, Inc. as your PCP.
Please call (989) 797-7601 if you want to
choose Health Delivery, Inc. 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 Bay 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 Bay Health Plan provider.
If you do receive a bill, DO NOT THROW
IT AWAY. DO NOT PAY IT. Call us at
(989) 797-7609.
You will be responsible for payment:
• if you get services that your Bay Health
Plan doctor has NOT authorized
• if you get services that are not covered
by Bay Health Plan.
• if you choose to get 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.
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Eat right
Get plenty of exercise
Control your stress
DON’T SMOKE
Say NO to drugs and alcohol
Practice safety
Disenrollment from Bay Health
Plan
Other Insurance
You will not be eligible for enrollment
in Bay Health Plan or the Adult Benefits
Waiver program if you become eligible
for any kind of medical insurance.
Please notify the Bay County Michigan
Department of Human Services office
(formerly known as the Bay County
Family Independence Agency or FIA)
if you get other medical insurance
coverage.
Moving out of Bay County
You will not be eligible for enrollment
in Bay Health Plan if you move out of
Bay County. You may be eligible for the
Adult Benefits Waiver program in the
new county. Contact the Bay County
Michigan Department of Human
Services office (formerly known as
the Bay County Family Independence
Agency or FIA) for assistance at (989)
895-2100. This is a local number.
Change of Income
Please notify your Bay County Michigan
Department of Human Services office
(formerly known as the Bay County
Family Independence Agency or FIA)
caseworker of any change in income or
circumstances at (989) 895-2100. This is
a local number.
Request for Disenrollment
Bay Health Plan may request that
Michigan Department of Community
Health disenroll you if:
1.You let someone else use your Bay
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
Bay Health Plan without your PCP’s
okay
d.Acts of fraud
e.Threats, life threatening or otherwise
Bay 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
Bay Health Plan at (989) 797-7609.
Fraud
You may lose your eligibility and be
subject to legal action if you commit
fraud against Bay Health Plan and/or
the Adult Benefits Waiver. Lying to get a
benefit that is not in your contract is an
example of fraud.
Grievance Process
Please call us if you have a question or
concern about Bay Health Plan.
The number to call is (989) 797-7609.
You may file a grievance if you disagree
with Bay Health Plan’s decision to deny
a service. We will try our best to answer
your questions and resolve any issues.
However, you have a right to make a
formal grievance if you are not satisfied
with the response. You may file a
grievance by:
1.Calling (989) 797-7609 or writing to
Bay Health Plan
P.O. Box 1700
Flint, MI 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.
3.If you are not satisfied with the
decision, you may request an appeal.
5
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 Bay
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 Bay 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 Bay Health Plan providers and
staff with respect
• To choose a doctor and keep
appointments
• To be honest when giving 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 Bay
Health Plan or your doctor
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Statement of Confidentiality
As a Bay 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. We will only disclose
your information for certain purposes
unless you give us permission in writing.
These purposes included 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.
• Business Operations–We may need to
use and disclose information for our
business operations.
• Health Related Benefits and Services–
We may contact you about other
health-related benefits and services.
• Exceptions–We may need your
permission to release your records
for treatment, payment and business
operations. This applies only to certain
kinds of records.
• 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
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 Bay 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–Bay
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 in effect for
medical information we already have
about you. It will also be in effect for any
information we may get 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 get a copy in
the mail of any new notice that contains
important changes.
Complaints to the Federal
Government
You may file a complaint with the federal
government if you believe that your
privacy rights have been violated.
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
Email: [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 a copy of
this notice at any time. You may continue
to get a paper copy of this notice
even if you have agreed to receive it
electronically. Please call or write to us
at the address listed “Under Complaints
and Communications to Us” to request
a copy.
Enrollment Card (ID Card): A card that
you receive when you are enrolled in
Bay Health Plan. The card lets providers
know you belong in Bay 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 Bay 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.
How to Use Your Rights Under This
Notice
If you want to use your rights under this
notice, you may call us or write to us. If
your request to us must be in writing,
we will help you prepare your written
request, if you wish.
Provider: Refers to anyone providing
medical services. It usually means a
doctor.
Complaints and Communications to Us
If you want to
Copay: The part of a medical expense
that you must pay for.
• exercise your rights under this notice
• communicate with us about privacy
issues or
• file a complaint
You may write to:
Privacy Officer
Bay Health Plan
P.O. Box 1700
Flint, MI 40501-1700
(989) 797-7609
TDD for the deaf 1-800-992-5070
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.
You will not be penalized for filing a
complaint.
Enrollee: A person who is a member of
Bay Health Plan.
Covered Services: Medical and supply
services provided through your Adult
Benefits Waiver program. This is paid for
by Bay Health Plan.
Eligibility: When you qualify for coverage under the Adult Benefits Waiver
Program.
Enrollment: To be covered under
Bay 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 Bay
Health Plan.
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