Member Handbook Iowa - Amerigroup
MemberHandbookIowaIA Health Link HawkiHealth and Wellness Planmyamerigroup.com/iaIA-MHB-0015-20
Member HandbookIowaIA Health Link Hawki Iowa Health and Wellness PlanMember Services 800-600-4441myamerigroup.com/IAIA-MHB-0015-20
Amerigroup Iowa, Inc. follows Federal civil rights laws. We don’t discriminate against people becauseof their: Race Color National origin Age Disability Sex or gender identityThat means we won’t exclude you or treat you differently because of these things.Communicating with you is importantFor people with disabilities or who speak a language other than English, we offer these services at nocost to you: Help from qualified interpreters and written Qualified sign language interpretersmaterials in the language you speak Written materials in large print, audio,electronic, and other formatsTo get these services, call the Member Services number on your ID card. Or you can call ourGrievance Coordinator at 800-600-4441 (TTY 711).Your rightsDo you feel you didn’t get these services or we discriminated against you for reasons listed above? Ifso, you can file a grievance (complaint). File by mail, email, fax, or phone:Grievance CoordinatorPhone: 800-600-4441 (TTY 711)4800 Westown Parkway, Regency Building 3Fax: 844-400-3465West Des Moines, IA 50266Email: iga@amerigroup.comNeed help filing? Call our Grievance Coordinator at the number above. You can also file a civil rightscomplaint with the U.S. Department of Health and Human Services, Office for Civil Rights: On the web:https://ocrportal.hhs.gov/ocr/portal/lobby.jsf By mail:U.S. Dept. of Health and Human Services200 Independence Ave., SW Room 509F, HHH BuildingWashington, DC 20201 By phone: 800-368-1019 (TTY/TDD 800-537-7697)For a complaint form, visit hhs.gov/ocr/office/file/index.html.IA-MEM-0471-18
Multi-Language Translation Services InformationDo you need help with your health care, talking with us or readingwhat we send you? We provide our materials in other languages andformats at no cost to you. Call us toll free at 1-800-600-4441 (TTY 711).¿Necesita ayuda con su cuidado de la salud, para hablar con nosotros o leerlo que le enviamos? Proporcionamos nuestros materiales en otros idiomasy formatos sin costo alguno para usted. Llámenos a la línea gratuita al1-800-600-4441 (TTY711).Spanish
IA-MEM-0371-17
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or havedifficulty speaking, call 711.Llame al 711, (teléfono de texto para personas con problemas de audición, del habla yceguera) si necesita asistencia telefónicamente.
MEMBER HANDBOOKWelcomeImportant Contact InformationYour ID CardsAccessibilityEligibilityIf You MoveIf You are No Longer Eligible for Medicaid or HawkiRenewal and Changes in Your CoverageIA Health LinkIowa Health and Wellness PlanHawkiCovered Benefits and ServicesMedical BenefitsVision BenefitsTransportation BenefitsDental BenefitsGoing to the DoctorPicking your Primary Care Provider (PCP)Going to your r (OTC) MedicinesEmergency and Urgent CareEmergenciesUrgent CareHospital ServicesRoutine CareMember CostsCopaysMember Liability/Client ParticipationValue-Added ServicesWellness CareWellness Care for AdultsWellness Care for ChildrenCare for Pregnant MembersCare ManagementTABLE OF 434444474748496363656973Amerigroup 1IA-MHB-0015-20
Behavioral HealthLong-Term Services and SupportsHome- and Community-Based Services (HCBS)Consumer Choices OptionConsumer-Directed Attendant CareHealth Home ProgramYour Rights and ResponsibilitiesOther Insurance and BillsIf You Have MedicareGrievance and AppealsOmbudsmanEstate RecoveryMaking a Living WillFraud, Waste and AbuseNotice of Privacy PracticesOther Plan DetailsGlossary of TermsAppendixTABLE OF 29139Amerigroup 2IA-MHB-0015-20
WELCOMEWELCOMEA Special Note from Amerigroup Iowa, Inc.Welcome to Amerigroup Iowa, Inc. Thank you for being our member! As your managedcare organization (MCO), we look forward to providing you with quality healthcarebenefits and services.This member handbook helps you understand how to work withus and how to get healthcare for you or your family when you need it.Your Amerigroup member identification (ID) card will be sent to you in a separatemailing. Please check your ID card as soon as you receive it. If any information is notright, please call us at 800-600-4441 (TTY 711). We’ll send you a new ID card with thecorrect information.When you join our plan, we’ll ask you to complete a health risk assessment to help uslearn about your health and arrange your care in a way that meets your individualneeds. It’s simple and only takes a few minutes to do. Your information will remainprivate. To complete it: Fill out and return the paper copy you receive in the mail in the postage-paid,self-addressed return envelope provided or Log in and complete the health risk assessment online at myamerigroup.com/IAYou can get Healthy Rewards debit card dollars for completing the health screener. Goto the Value-Added Services section of this document to learn more about HealthyRewards.Thank you again for being an Amerigroup member.Important Contact InformationAmerigroup Member Services800-600-4441Hours of operation: Monday through Friday from 7:30 a.m. to 6 p.m. Central time, except for holidays. If you call after 6 p.m., leave a voicemail message, and one of our Member Servicesrepresentatives will call you back the next working day.Amerigroup 3IA-MHB-0015-20WELCOMEBased on your answers, you may qualify for case management. There is no cost toyou for this service. Learn more about case management in the Case Managementsection of this document.
Our Member Services representatives can answer your questions about how to get anew ID card, find a new primary care provider (PCP), and more.Online tools available 24/7Register online at myamerigroup.com/IA and: Change your PCP. Send us a secure message. Print your ID card. Tell us how you want to get information about your health plan — by mail orelectronically.Without logging in, you can always: View the latest provider directory and search for a PCP in our plan. Find helpful tips to stay healthy.WELCOMEYou can also email or send a letter to Member Services with questions or concerns at: Email: mpsweb@amerigroup.com Mail:Amerigroup Iowa, Inc.P.O. Box 62509Virginia Beach, VA 23466-250924-hour Nurse HelpLine866-864-2544 (TTY 711)24-hour Nurse HelpLine is here for you 24 hours a day, 7 days a week, 365 days a year.A nurse can: Help you set up an appointment with a doctor for an urgent medical issue. Answer your health questions. Give you advice on how soon you need to get care and how to take care of yourselfbefore you see the doctor.Non-Emergency Medical Transportation (NEMT): Access2CareFor reservations, call 844-544-1389.For help with your ride, call Where’s My Ride at 844-544-1390.Call these numbers to arrange transportation to an IA Health Link-covered service or tolearn how to get paid back for mileage, meals, or lodging for a medical appointment.Some limits apply.Amerigroup 4IA-MHB-0015-20
Vision: Superior VisionFor vision services, call 800-879-6901.State Contact InformationIowa Medicaid Enterprise (IME) Member Services800-338-8366Call this number for MCO choice counseling and enrollment for IA Health Linkmembers. IME Member Services can also help with premium payments and financialhardship requests for Iowa Health and Wellness Plan members.Hours: Monday to Friday, 8 a.m. to 5 p.m.You can also email IME Member Services at IMEMemberServices@dhs.state.ia.us.Hawki Customer Service800-257-8563Call this number for MCO choice counseling and enrollment for Hawki members.Hawki Customer Service can also help with premium payments and questions.Hours: Monday to Friday, 8 a.m. to 5 p.m.Iowa Department of Human Services (DHS) Contact Center855-889-7985Call this number if you are new to Medicaid and have application questions.Hours: Monday to Friday, 7 a.m. to 6 p.m.Your ID CardsIf you’re a new member, your Amerigroup member ID card is sent separately from yournew member packet. You’ll also get an Iowa Medicaid card. If you’re enrolled inMedicare, you have an ID card through the Medicare program, too. It’s important youcarry your ID cards with you at all times. You’ll need to show them each time you getmedical care or fill prescriptions at a pharmacy.Your Amerigroup ID card tells providers and hospitals: You’re a member of our health plan. We’ll pay for the medically necessary covered benefits listed in the section CoveredBenefits and Services.Amerigroup 5IA-MHB-0015-20WELCOMEIowa Department of Human Services (DHS) Income Maintenance CustomerService Center877-347-5678Call this number to report changes for continued Medicaid eligibility, such as whenemployment starts and ends.Find your local DHS office: https://dhs.iowa.gov/dhs office locatorHours: Monday to Friday, 7 a.m. to 6 p.m.
Your Amerigroup ID card shows: The name and phone number of your PCP (if you’re not enrolled in Medicare). Your Medicaid or Hawki identification number. The date you became an Amerigroup member. Your date of birth. Your Amerigroup identification number. Phone numbers you need to know, such as:- Our Member Services department.- 24-hour Nurse HelpLine.- Getting help with finding a network vision care provider. What you need to do if you have an emergency.Need your Amerigroup ID card right away but don’t have it with you?We offer printable ID cards — just log in to our secure website. Or get our freeAmerigroup mobile app on your smartphone or tablet and: View your Amerigroup member ID card. View Amerigroup member ID cards for family members who live with you. Email or fax your card to your doctor, yourself, or someone else.WELCOMEIf your Amerigroup ID card is lost or stolen, call us right away at 800-600-4441(TTY 711). We’ll send you a new one.Amerigroup 6IA-MHB-0015-20
ACCESSIBILITYACCESSIBLITYWe want to make sure you understand your benefits. If you have trouble reading whatwe send you or communicating with us, we can help.To get a large print, braille, or an audio CD version of this handbook or any other writtenmaterial, call Member Services at 800-600-4441 (TTY 711). We’ll mail it to you, free ofcharge.For members who don’t speak English, we offer help in many different languages. CallMember Services to get any of these services at no cost to you: Over-the-phone interpreter services Interpretation at your doctor visits, within 24 hours’ notice This member handbook or any other written materials in your preferred languageAmerigroup 7IA-MHB-0015-20ACCESSIBILITYFor members who are deaf or hard of hearing: Call 711 using a TTY relay service. We’ll set up and pay for you to have a person who knows sign language help youduring your doctor visits, with 24 hours’ notice.
ELIGIBILITYELIGIBILITYIf you moveCall to report your new address to: The Department of Human Services, Income Maintenance Customer CallCenter (DHS-IMCSC) at 877-347-5678, or Hawki Customer Service at 800-257-8563 (TDD 515-457-8051 or888-422-2319)You must first update your address with DHS at one of the phone numbers above.Then, call Amerigroup Member Services and let us know.You’ll continue to get healthcare services before and after your move.If you are no longer eligible for Medicaid or HawkiYou’ll be disenrolled from Amerigroup if you’re no longer eligible for Medicaid orHawki benefits. If you’re ineligible for Medicaid for two months or less and then becomeeligible again, you’ll be re-enrolled in Amerigroup. If possible, you’ll be given the sameprimary care provider (PCP) you had when you were enrolled in Amerigroup before.Renewal and changes in your coverageStep 1: Watch your mailYou’ll receive a renewal form from the Iowa Department of Human Services (DHS). Look for your form up to 45 days before your coverage will end. Moved? Make sure DHS has your current address. Call 877-347-5678 if youraddress has changed.Step 2: Complete the renewal formComplete the renewal form when you receive it. Fill out all the information on each page. Be sure to sign the signature page.Step 3: Return the renewal formReturn the form to DHS by the due date. Use the prepaid, self-addressed envelope you received with your form.Amerigroup 9IA-MHB-0015-20ELIGIBILITYKeep your health coverage! Renew your family’s IA Health Link or Hawki benefitseach year with these simple steps.
Don’t have the envelope? You can mail the renewal form to the image center listedon the renewal form or return it to any DHS office.You’re almost finished! Look for next steps in the mail from DHS. If DHS needs more information, you’ll receive a letter that tells you what theyneed. If DHS has all the information, you’ll receive a Notice of Action (NOA) that tellsyou if your coverage will change.Not sure what you need to do? We can help. Call an Amerigroup retention specialist tollfree at 877-269-5707 (TTY 711), or call the DHS Contact Center at 855-889-7985.Change in benefitsSometimes, Amerigroup may have to change the way we work, your covered services,or our network providers and hospitals. The Iowa Department of Human Services mayalso change the covered services that we arrange for you. If this happens, we’ll sendyou a letter telling you about changes to your plan benefits.Notice of significant change about your PCPELIGIBILITYYour PCP’s office may move, close or leave our plan. If this happens, we’ll tell youwithin 15 days of the change. We can help you pick a new PCP and send you a new IDcard within five working days after you pick a new PCP. Call Member Services at800-600-4441 (TTY 711).Amerigroup 10IA-MHB-0015-20
IA HEALTH LINKIA HEALTH LINKMost members who get health coverage from Iowa Medicaid are enrolled in the IAHealth Link managed care program. A Managed Care Organization, or MCO, is a healthplan that coordinates your care. Amerigroup Iowa, Inc. is your MCO. The benefits youreceive from Amerigroup depend on the type of Medicaid coverage you have. To learnmore about the benefits and services you may be able to get, refer to the CoveredBenefits and Services section of this document.IA HEALTH LINKAmerigroup 11IA-MHB-0015-20
IOWA HEALTH AND WELLNESS PLANplanPLANIOWA HEALTH AND WELLNESS PLANThe Iowa Health and Wellness Plan provides health coverage at low or no cost toIowans. Members are between the ages of 19 and 64. Eligibility is based on householdincome. To learn more about the benefits and services you may be able to get, refer tothe Covered Benefits and Services section of this document.Healthy Behaviors for Iowa Health and Wellness Plan Members1. Get a Wellness Exam -OR- Get a Dental ExamAND2. Complete a Health Risk AssessmentMonthly Contributions Members will receive free* health coverage under the Iowa Health and WellnessPlan in their first year of eligibility. Members must complete their Healthy Behaviors in their first year, and every yearafter, to continue to receive free health services for the following year. Members who do not complete their Healthy Behaviors every year may be requiredto pay a small monthly contribution that depends on their family income. Monthly contributions are either 5 or 10, depending on a member’s family income. Members who do not complete their Healthy Behaviors and do not pay their monthlybill after 90 days, depending on their income, may be disenrolled from the IowaHealth and Wellness Plan.* There are very few, or no, costs for the first year and very few costs after that. A smallmonthly payment may be required based on income. There is an 8 copay for using theemergency room for non-emergency services.Wellness ExamIn a wellness exam, your healthcare provider will do things like check your bloodpressure and pulse, listen to your lungs with a stethoscope, recommend preventivescreenings or take a blood sample to check your cholesterol.Amerigroup 13IA-MHB-0015-20IOWA HEALTH AND WELLNESS PLANMembers in the Iowa Health and Wellness Plan can get free* healthcare if theycomplete what are known as Healthy Behaviors. To participate in the Healthy Behaviorsprogram and avoid monthly payments after the first year, each year Iowa Health andWellness Plan members must:
Dental ExamIn a dental exam, your dentist will go over your dental health. You may receive acleaning or basic X-rays.Health Risk Assessment (HRA)In addition to your Wellness Exam -OR- Dental Exam, you must also complete a HealthRisk Assessment. Set aside 15–40 minutes to complete a survey that asks questionsabout your health and your experience in getting health services.IOWA HEALTH AND WELLNESS PLANTo complete your HRA contact Amerigroup Member Services: 800-600-4441(TTY 711)Financial HardshipIf you are unable to pay your contribution, you may check the hardship box onyour monthly statement and return the payment coupon OR call the IowaMedicaid Enterprise (IME) Member Services at 800-338-8366. Important: Claimingfinancial hardship will apply to that current month’s amount due only. You will still beresponsible for amounts due from past months. You will also be responsible foramounts due in future months unless you claim hardship in those months. Any paymentthat is more than 90 days past due will be subject to recovery and, depending on yourincome, you may be disenrolled.Notice: Dental Wellness Plan members also have ‘Healthy Behaviors’ to complete fordental coverage. Find information on these in the ‘Dental Benefit’ section of thishandbook.Amerigroup 14IA-MHB-0015-20
HawkiHawkiThe Healthy and Well Kids in Iowa (Hawki) program offers health insurance to childrenwho have no other health insurance. Members are under 19 years of age. Eligibility isbased on household income. No family pays more than 40 per month. Somefamiliespay nothing at all. To learn more about the benefits and services you may beable to get, refer to the Covered Benefits and Services section of this document.HawkiAmerigroup 15IA-MHB-0015-20
COVERED BENEFITS AND SERVICESCOVERED BENEFITS AND SERVICESMedical benefitsBelow is a summary of the healthcare services and benefits you have access to. Checkthe chart based on whether or not you’re in IA Health Link, Iowa Health and WellnessPlan, or Hawki. Your primary care provider (PCP) will either: Give you the care you need or Refer you to a provider who can give you the care you need1915(I) HABILITATIONSERVICES*ABORTIONSALLERGY TESTING ANDINJECTIONSANESTHESIA*ASSERTIVE COMMUNITYTREATMENT (ACT)IA Health LinkCovered Must meet thelevel of care forthe specificwaiver Must meet theneed-basedeligibility criteria,with an incomebelow 150percent FederalPoverty Level(FPL) Certaincircumstancesmust apply.ContactAmerigroupMemberServices. Iowa Health andWellness PlanCoveredCovered Certaincircumstances mustapply. ContactAmerigroupMember Services. HawkiCertaincircumstancesmust apply.ContactAmerigroupMemberServices. Amerigroup 17IA-MHB-0015-20COVERED BENEFITS AND SERVICESServices* prior authorization maybe required1915(C) HOME- ANDCOMMUNITY-BASEDSERVICES*
COVERED BENEFITS AND SERVICESServices* prior authorization maybe required(b)(3) SERVICES(INTENSIVE PSYCHIATRICREHABILITATION,COMMUNITY SUPPORTSERVICES, PEERSUPPORT, RESIDENTIALSUBSTANCE USETREATMENT,INTEGRATED SERVICESAND SUPPORTS,RESPITE)*BARIATRIC SURGERYFOR MORBID OBESITY*BEHAVIORAL HEALTHINTERVENTIONSERVICES (INCLUDINGAPPLIED BEHAVIORANALYSIS)*BREASTRECONSTRUCTION(FOLLOWING BREASTCANCER ANDMASTECTOMY)*CARDIACREHABILITATION*CERTIFIED NURSEMIDWIFE SERVICESCHEMOTHERAPY*CHILD CARE MEDICALSERVICESCHIROPRACTIC CARE(LIMITATIONS APPLY)*COLORECTAL ICESCONTRACEPTIVEDEVICESIA Health LinkCovered Iowa Health andWellness PlanCovered HawkiCovered Residential notcovered Limitations mayapply. (Medicall
IA-MEM-0471-18 Amerigroup Iowa, Inc. follows Federal civil rights laws. We don’t discriminate against people because of their: Race Color
Amerigroup Texas, Inc. and Amerigroup Insurance Company (Amerigroup) provides the Medicaid CHIP, STAR, STAR PLUS, and MMP - Dual Demo programs to eight service delivery areas in Texas: Bexar, El Paso, Harris, Jefferson, Lubbock, Medicaid Rural Service Area-West, Tarrant, and Travis (see Appendix 3 for additional information on
Medicare Advantage https://providers.amerigroup.com * LiveHealth Online is an independent company providing telehealth services on behalf of Amerigroup. Coverage provided by Amerigroup Inc. AGPCARE-0507-20 510610MUPENABS June 2020 COVID-19 information from Amerigroup (June 5 update)
Provider update https://providers.amerigroup.com TNPEC-3202-20-C Coverage provided by Amerigroup Inc. April 2020 COVID-19 information from Amerigroup Community Care (April 9 update) . Amerigroup will waive any normally required cost shares for Medicare and Medicaid members — including of copays, coinsurance and deductibles — for COVID-19 .
Welcome to Amerigroup! Amerigroup is a managed care organization committed to helping you get the right care for your needs. As a member of the Amerigroup STAR PLUS program, you and your primary care provider or doctor will work together to help keep you healthy and care for your health problems.
Iowa Chapter, American Academy of Pediatrics Iowa Dental Association Iowa Department of Public Health Iowa Health Care Association Iowa Hospital Association Iowa Medical Society Iowa Nurses Association Iowa Pharmacy Association Iowa Veterinary Medical Association Iowa‘s Statewide Epidemiology Education and Consultation Program State Hygienic .
Sep 01, 2018 · This is a list of drugs that members can get in Amerigroup STAR PLUS MMP (Medicare-Medicaid Plan). Amerigroup STAR PLUS MMP is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year.
Amerigroup – By participating in Caremark’s national pharmacy networks, you automatically participate in the pharmacy network Amerigroup will be using for its State of Texas Medicaid STAR, STAR PLUS and CHIP program members – Caremark’s national network is CareValue3 – Other criteria to participate is detailed on the following pageFile Size: 1MB
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