STAR+PLUS Member Handbook—English

MY CIGNA STAR+PLUS MEMBER HANDBOOK

Member Services 1-877-653-0327 (TTY: 7-1-1) Monday to Friday 8 a.m. to 5 p.m. Central Time June 2021

MCDTX_21_97277

Introduction toIntroduction Cigna

WELCOME TO BETTER HEALTH. We’re here to help in every way.

Thank you for choosing Cigna as your STAR+PLUS plan. We look forward to helping you improve your health, well-being and sense of security. Our goal is to help you live a healthier, happier life. This includes helping you get quality care that is easy to understand and able to meet your individual needs.

This Member Handbook can help you get the most from your STAR+PLUS plan. Please read it carefully and keep it in a safe, convenient place.

You will learn many important things from your Member Handbook, such as: › The role of your Primary Care Provider (PCP). › How to find out what drugs are covered on the preferred drug list. › When you need a referral or prior authorization from your Primary Care Provider. › Who to call and what to do if you become ill or injured. › How to take advantage of preventive health services and other benefits. At Cigna, we want you to be involved in your own health. Be sure to take an active role by carefully listening to and following the advice of your Primary Care Provider. It also means you should call us when you have a question about your health plan. We are always ready to help you.

If you have questions about your STAR+PLUS plan, please call Member Services at 1-877-653-0327 (TTY: 7-1-1), Monday to Friday, 8 a.m. to 5 p.m. Central Time. If you have questions about your health, you can talk to the nurses at our 24-Hour Health Information Line anytime day and night. Call toll-free 1-855-418-4552 (TTY: 7-1-1).

Also, this Member Handbook will be made available in audio, larger print, Braille or another language when a Member requests it or when Cigna identifies a Member who needs it.

On behalf of the entire Cigna family in Texas, I welcome you. Let’s work together to help you live a healthier, happier life. Sincerely,

Dee Cavaness Interim Medicaid Plan President Cigna Medicaid

a CALL US WHEN YOU NEED HELP. It is important that you know where to turn Alternate formats when you need help. Your team is ready This Member Handbook can be made to guide you in the right direction. If you available in audio, larger print, Braille have a health question or concern, you or other languages at no cost. To make can call the nurses at our 24-Hour Health your request, call Member Services at Information Line at 1-855-418-4552. If 1-877-653-0327 (TTY: 7-1-1), Monday to you need help or information, call Member Friday, 8 a.m. to 5 p.m. Central Time.

Important phone numbers Services at 1-877-653-0327 (TTY: 7-1-1). You can also reach our mental health After-hours crisis line 24 hours a day, 7 days a If you call after-hours, on a weekend week by calling 1-800-959-4941. or holiday, you can leave a voice message, and we will return your call on the next Business Day.

Service Coordination Cigna provides Service Coordination. Important You and your Service Coordinator will work together to: If you have a life-threatening Assess your health needs. emergency or an emergency that › poses a threat to the life or property › Create a care plan. of others, call 9-1-1 or go directly › Coordinate your health care needs. to the nearest emergency room. › Monitor your progress toward your health care goals. Cigna Member Services You can call your Cigna Service Coordinator at 1-877-725-2688, Monday You can get immediate answers to to Friday, 8 a.m. to 5 p.m. Central Time. questions about your benefits, the provider network or any other issues related to Behavioral health and your plan. Please call Member Services substance abuse services at 1-877-653-0327 (TTY: 7-1-1), Monday to Friday, 8 a.m. to 5 p.m. Central Time, For questions about behavioral health excluding State approved holidays. and substance abuse services, call the behavioral health line at 1-877-725-2539. If you have a mental health crisis, you Bilingual or interpreter services can get help by calling our mental health Cigna representatives are ready to help crisis line at 1-800-959-4941, 24 hours in English and Spanish. Cigna can provide a day, 7 days a week. Qualified mental interpreter and translation services in more health professionals will be ready to: than 170 languages. Please call Member › Answer your questions. Services at 1-877-653-0327 (TTY: 7-1-1) for assistance. › Assess your mental health. › Provide and coordinate Deaf or hard of hearing services as needed. If you are deaf or hard of hearing, please They can also help in English and Spanish. Cigna can provide interpreter call TTY: 7-1-1. For more services, please and translation services. call TTY/Texas Relay at 1-800-735-2989 (English) or 1-800-662-4954 (Spanish). If you have an emergency, please call 9-1-1. b Important phone numbers phone Important

24-Hour Health Information Line STAR+PLUS Helpline Cigna gives you access to experienced The STAR+PLUS Helpline assists with joining registered nurses 24 hours a day, 365 days a health plan or changing health plans. a year. Our nurses offer immediate, reliable For more information, call 1-800-964-2777 information for any health concern. Please (TTY: 1-800-735-2989). call 1-855-418-4552 (TTY: 7-1-1). Help is ready in English or Spanish. Nonemergency Medical For additional interpreter services, Transportation (NEMT) please call Member Services at NEMT services provide transportation to 1-877-653-0327, Monday to Friday, nonemergency health care appointments 8 a.m. to 5 p.m. Central Time. for eligible Medicaid members who have no other transportation options. Eye care These trips include rides to the doctor, Members who only have Medicaid and dentist, hospital, pharmacy, and other no other insurance can get routine eye places you get Medicaid services. These care services by calling Superior Vision at trips do NOT include ambulance trips. 1-888-886-1995, Monday to Friday, 7 a.m. To schedule a ride call Access2Care at to 8 p.m. Central Time. If you need eye 1-888-721-8184 (TTY: 7-1-1), Monday care for an illness or injury to your eye, call to Friday, 8 a.m. to 5 p.m. Central Time, your Primary Care Provider for help first. excluding State approved holidays. For You do not need a referral for specialty Where’s my ride call 1-888-721-8184 eye care from an ophthalmologist. (TTY: 7-1-1), Monday to Saturday, 8 a.m. to 7 p.m. Central Time. See page 16 for Dental care additional information on NEMT services. Some Members may be eligible Access2Care representatives are ready to for limited dental services. To find help in English and Spanish. Interpreter out more about coverage, call and translation services are available. DentaQuest at 1-855-418-1628. How do I prepare for an emergency Ombudsman Managed Care or natural disaster? Assistance Team For information on how to prepare for an The Health and Human Services emergency or disaster such as hurricanes Commission Office of the Ombudsman and other tragic events, Members can call helps people with Medicaid managed care: Texas 2-1-1 for assistance. Texas 2-1-1 is › Navigate the managed care system. available 24 hours a day, 7 days a week. 2-1-1 can also help you connect with › Understand their Medicaid coverage. services that you may need, such as Understand their rights. › help finding food or housing, child care, › Advocate for themselves. crisis counseling or substance abuse › Resolve problems, including treatment. Call 9-1-1 for immediate access to care. help in an emergency, or if you are Call the Ombudsman Managed Care in need of life-saving assistance. Assistance Team at 1-866-566-8989 Resource: 211texas.org/about-2-1-1/ (TTY: 1-866-222-4306) for assistance.

c QUICK REFERENCE GUIDE.

IMPORTANT PHONE NUMBERS FOR MEMBERS

Member Services 1-877-653-0327 (TTY: 7-1-1)

Bilingual/interpreter services 1-877-653-0327

Service Coordination 1-877-725-2688 Important phone numbers

Behavioral health and substance abuse 1-877-725-2539

Mental health crisis line 1-800-959-4941

24-Hour Health Information Line (English/Spanish) 1-855-418-4552

Eye care 1-888-886-1995

Dental care 1-855-418-1628

Medicaid prescription helpline 1-877-653-0327

ADDITIONAL HELPFUL PHONE NUMBERS

TTY/Texas Relay English 1-800-735-2989

TTY/Texas Relay Spanish 1-800-662-4954

1-866-566-8989 Ombudsman Managed Care Assistance Team TTY: 1-866-222-4306

STAR+PLUS Program Help Line 1-800-964-2777

Texas Benefits Medicaid card 1-855-827-3748

2-1-1 Help in Texas 2-1-1

Nonemergency Medical Transportation (NEMT)

- Schedule a Ride 1-888-721-8184 (TTY: 7-1-1) - Where’s my Ride? 1-888-721-8184 (TTY: 7-1-1)

d Table of contents TABLE OF CONTENTS.

Introduction to Cigna �� a

Important phone numbers �� b Cigna Member Services �� b Bilingual or interpreter services �� b Deaf or hard of hearing �� b Alternate formats �� b After-hours �� b Service Coordination �� b Behavioral health and substance abuse services �� b 24-Hour Health Information Line �� c Eye care �� c Dental care �� c Ombudsman Managed Care Assistance Team �� c STAR+PLUS Helpline �� c Nonemergency Medical Transportation (NEMT) �� c How do I prepare for an emergency or natural disaster? �� c Quick Reference Guide �� d

Welcome to Cigna �� 1 What is Cigna? �� 1 What does Cigna STAR+PLUS do? �� 1 What does Cigna offer? �� 1

Your Cigna ID card �� 2 How to use your ID card �� 2 How to read your ID card �� 2 How to replace your ID card �� 3 Your Texas Benefits (YTB) Medicaid card �� 4 Temporary verification form (Medicaid Form 1027-A) �� 5

Interpretation services �� 6 Can someone interpret for me when I talk with my doctor? �� 6 Who do I call for an interpreter? �� 6 How far in advance do I need to call? �� 6 How can I get a face-to-face interpreter in the provider’s office? �� 6

Your Primary Care Provider �� 6 What is a Primary Care Provider? �� 6 Will I be assigned a Primary Care Provider if I have Medicare? �� 6 How do I choose my Primary Care Provider? �� 6 What type of provider can I choose as my Primary Care Provider? �� 6 What if I cannot find a Primary Care Provider (PCP), Specialist, or Other Provider close to where I live? �� 6 How can I change my Primary Care Provider? �� 7 When will my Primary Care Provider change become effective? �� 7 Can a specialist ever be considered a Primary Care Provider? �� 7 Can a clinic be my Primary Care Provider? �� 7 How can I change my Primary Care Provider if I receive Medicare benefits? �� 7 How many times can I change my/my child’s Primary Care Provider? �� 7 Are there any reasons why a request to change a Primary Care Provider may be denied? �� 7 When should I call to make an appointment? �� 8 What do I need to bring with me to my doctor’s appointment? �� 8 Table of contents of Table Can my Primary Care Provider switch me to another Primary Care Provider for non-compliance? �� 8 What if I choose to go to another provider who is not my Primary Care Provider? �� 8 How do I get medical care when my Primary Care Provider’s office is closed? �� 8 What is the physician incentive plan? �� 9

Changing health plans �� 9 What if I want to change health plans? �� 9 Who do I call? �� 9 How many times can I change health plans? �� 9 When will my health plan change become effective? �� 9 Can Cigna ask that I get dropped from their health plan (for non-compliance)? �� 9

Service Coordination �� 10 What is Service Coordination? �� 10 What will a Service Coordinator do for me? �� 10 How can I talk with a Service Coordinator? �� 10

Health care benefits �� 10 What are my health care benefits? �� 10 How do I get these services? �� 12 Are there any limits to any covered services? �� 12 What are Long Term Services and Supports (LTSS) benefits? �� 12 How do I get these services? �� 12 What number do I call to find out about these services? �� 13 What is Cognitive Rehabilitation Therapy (CRT)? �� 13 How do I get CRT? �� 13 What are Consumer Directed Services and Financial Management Services agencies? �� 13 Who do I call to learn more about CDS? �� 13 Will my STAR+PLUS benefits change if I am in a Nursing Facility? �� 13 What are my Acute Care benefits? �� 13 How do I get these services? �� 13 What number do I call to find out about these services? �� 13 What services are not covered? �� 13 What is the Intermediate Care Facility–Intellectual and Developmental Disability (ICF-IDD) program? �� 14 What programs support the IDD waiver? �� 14 What services am I eligible for as an ICF-IDD program or IDD waiver member? �� 14 What services am I eligible for as a Medicaid for Breast and Cervical Cancer (MBCC) Member? �� 14 What extra benefits do I get as a Member of Cigna? �� 14 Table of contents What Value-added Services can Cigna STAR+PLUS Dual Members get? �� 14 What Value-added Services can Cigna STAR+PLUS Medicaid-only Members get? �� 15 How can I get these benefits? �� 15 What health education classes does Cigna offer? �� 15 What is the “My Personal Health Coach” program? �� 15 How can I contact My Personal Health Coach? �� 15 What other services can Cigna help me get? �� 15 Can Cigna help me get non-covered community resources? �� 16

Eye care �� 16 How do I get eye care services? �� 16

Nonemergency Medical Transportation (NEMT) �� 16 What are NEMT services? �� 16 What services are part of NEMT? �� 16 Who do I call for a ride to a medical appointment? �� 17

Prescription drugs and pharmacy benefits �� 17 What are my prescription drug benefits? �� 17 How do I get my medications? �� 17 How do I find a network drug store? �� 17 What if I go to a drug store not in the network? �� 17 What do I bring with me to the drug store? �� 17 What if I need my medications delivered to me? �� 18 Who do I call if I have problems getting my medications? �� 18 What if I can’t get the medication my doctor ordered approved? �� 18 What if I lose my medications? �� 18 What is Medication Synchronization? �� 18 Which medications may I request to fill early? �� 18 How can I request to fill a medication early? �� 18 What if I also have Medicare? �� 18 How do I get my medications if I am in a Nursing Facility? �� 18 What if I need Durable Medical Equipment (DME) or other products normally found in a pharmacy? �� 18 How do I get mosquito repellent spray to prevent Zika virus? �� 18 What is the Medicaid Lock-In Program? �� 19

Behavioral health �� 19 What are behavioral health services? �� 19 How do I get help if I have behavioral (mental) health, alcohol or drug problems? �� 19 How do I get emergency help for mental health or substance abuse issues? �� 19 Do I need a referral for this? �� 19 What are mental health rehabilitative services and mental health targeted case management? �� 19 How do I get these services? �� 20 What behavioral health services are available? �� 20 What outpatient substance abuse services are available? �� 20 What is a Behavior Health Case Manager? �� 20 Table of contents Family planning Family planning OB/GYN care Prenatal and pregnancy care care pregnancy and Prenatal Case management for children and pregnant women women pregnant and children for management Case Texas Steps Health How doIgetfamily planningservices? What ifIamalready intreatment? Do Ineedareferral for this? Can alocalmentalhealthauthorityclinicbemy behavioral healthcare provider? Where doIfinda family planningservices provider? What ifIneedOB/GYN care? Do Ihave therightto chooseanOB/GYN? How doIchooseanOB/GYN? If IdonotchooseanOB/GYN, doIhave direct access? Will Ineedareferral? Can Istay withmy OB/GYN ifthey are notwithCigna? What ifIampregnant? How sooncanIbeseenafter contacting my OB/GYN for anappointment? Who doIneedto call? What otherservices/activities/education doesCignaoffer pregnant women? Where canI findalist ofbirthing centers? How andwhencan Iswitch my baby’s PrimaryCare Provider? Can IpickaPrimaryCare Provider for my baby before thebaby isborn? How doIsignup my newborn baby? How andwhendo Itell my healthplan? covered by Medicaid? How canIreceive healthcare after my baby isborn ifIamnolonger How andwhendo Itell my caseworker? Need helpfindingandgettingservices? Who cangetacasemanager? What docasemanagersdo? What kindofhelpcan you get? How canyou getacasemanager? What isEarlyChildhood Intervention? Do Ineedareferral for this? Where doIfindanECIprovider? What isTexas HealthSteps? What services are offered by Texas Health Steps? for my child? How andwhendoIgetTexas HealthSteps medicalanddentalcheckups Does my doctor have to be partoftheCignanetwork? What dentalservices doesTexas HealthSteps offer for my child? Do Ihave to have areferral? What ifI needto cancel an appointment? ��

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�� 20 20 20 20 20 20 24 22 25 24 24 24 24 24 24 24 24 26 26 26 26 23 22 22 22 25 22 22 25 22 22 25 22 22 21 21 21 21 21 21 21 21 Table of contents What if I am out of town and my child is due for a Texas Health Steps checkup? �� 26 What if I am a migrant farmworker? �� 26 Child’s dental care �� 27 What dental services does Cigna cover for children? �� 27 Where to go when you need care �� 27 What does medically necessary mean? �� 27 What is routine medical care? �� 28 How soon can I expect to be seen? �� 28 What is urgent medical care? �� 28 What is an urgent care clinic? �� 28 What should I do if my child or I need urgent medical care? �� 28 How soon can I expect to be seen? �� 28 What is emergency medical care? �� 29 How soon can I expect to be seen? �� 29 Do I need a prior authorization? �� 29 Are emergency dental services covered by the health plan? �� 29 What do I do if my child needs emergency dental care? �� 29 What is post-stabilization? �� 30 What if I get sick when I am out of town or traveling? �� 30 What if I am out of the state? �� 30 What if I am out of the country? �� 30 What if I need to see a special doctor (specialist)? �� 30 What is a referral? �� 30 How soon can I expect to be seen by a specialist? �� 30 What services do not need a referral? �� 30 How can I ask for a second opinion? �� 30 Special needs and advance directives �� 31 Who do I call if I have special health care needs and need someone to help me? �� 31 What if I am too sick to make a decision about my medical care? �� 31 What are advance directives? �� 31 How do I get an advance directive? �� 31 What do I do with an advance directive? �� 31 How do I change or cancel an advance directive? �� 31 Bills, change of address, or lost or limited coverage �� 32 What if I get a bill from my doctor? �� 32 Who do I call? �� 32 What information will they need? �� 32 What do I have to do if I move? �� 32 What happens if I lose my Medicaid coverage? �� 32 What do I have to do if I need help with completing my renewal application? �� 32 Medicare-Medicaid beneficiaries (Duals) �� 33 What if I also have Medicare? �� 33 Can my Medicare provider bill me for services or supplies if I am in both Medicare and Medicaid? �� 33 What if I have other health insurance in addition to Medicaid? �� 33 Table of contents Rights and responsibilities Complaints Complaints Appeals Appeals Expedited Appeals Appeals Expedited State Fair Hearing Waste, abuse and fraud fraud and Waste, abuse Multi-language Interpreter ServicesMulti-language Exploitation and Neglect Abuse, Reporting Notice of nondiscrimination Annual information �� Terms definitions and What aremyrightsandresponsibilities? What shouldIdoifhave acomplaint? specific toElectronicVisitVerification(EVV)?�� What aremyrightsandresponsibilities Who doIcall? Can someonefrom Cignahelpmefilea complaint? How longwillittake to process my complaint? but Cignadeniesorlimitsit? What canIdoifmy doctor asksfor aservice ormedicinefor methat iscovered What are therequirements andtimeframes for filinga complaint? How willIfindoutifservices are denied? What isthetimeframe for anappeal? When doIhave therightto askfor anappeal? Can Ifile my appealorally? How canIkeep gettingservices whilemy appealisinprocess? Can someonefrom Cignahelpmefileanappeal? When canIaskaState Fair Hearingto review my appeal? What isanExpedited Appeal? Does my request have to beinwriting? How doIaskfor aprescription drug/pharmacy Expedited Appeal? How doIaskfor anExpedited Appeal?�� What are thetimeframes for anExpedited Appeal? What isthetimeframe for anemergency Expedited Appeal? Who canhelpmefileanExpedited Appeal? What happensifCignadeniestherequest for anExpedited Appeal? Can Iaskfor aState Fair Hearing? Where doI send my request for aState Fair Hearing? Helpful information for filinga report ��42 Reporting Abuse, NeglectandExploitation �� 42 What are Abuse, NeglectandExploitation? Who canItalkto aboutaState Fair Hearing? Can Ikeep gettingservices that are notapproved ifIfiled for a State Fair Hearing? Do you want to report Waste, AbuseorFraud? ��

�� 42 �� 42 ��

�� 40 40 40 40 40 40 40 40 40 46 34 42 45 42 43 34 38 38 36 47 39 39 39 39 39 39 38 38 38 38 38 38 38 41 41 41 41 41 Welcome to Cigna 1 24-Hour Health Information Line Help for deaf or hard of hearing Routine dental services dental Routine Eye care Over-the-counter health allowance products monthly Coordination Service services Transportation Member Services interpreter Bilingual or services Primary and specialty provider care supplies Medical and health Behavioral substance abuse services Hospital care What does Cigna offer?

You can call phone also the numbersYou Guide. Quick the in Reference listed Helpful hint Helpful questions, please call have If you Member Services 1-877-653-0327 at with health care choices that offer that quality care choices health with care outcomes. and health better What does Cigna STAR+PLUS do? What does Cigna STAR+PLUS help to Texas of state the with Cigna works coverage health get families and people Program. STAR+PLUS Texas the in Medicaid managed a Texas is STAR+PLUS care, health provides that care program Services and care and Term Long acute Cigna Supports. STAR+PLUS, Through quality Members health many provides with our with closely work care services. We to care professionals health of network our all ensure Members personalized get care and benefits meet health their that our Members give more we needs. Together, healthier – healthier – and get stay to ways What is Cigna? a leadingCigna is global care health people serving of company millions world. around the and communities can put feel when confident you You one are of Cigna. in trust We your companies care health largest the onfocused Medicaid and Medicare. DISCOVER THE DISCOVER CIGNA DIFFERENCE. CIGNA ENJOY PEACE OF MIND WITH CIGNA.

How to use your ID card Your Cigna ID card tells doctors and hospitals that you are a Member of our health plan. Take your ID card every time you go to the following: › Doctor’s visit. › Urgent care center. Your Cigna ID card Your › Laboratory testing. › Long-term care services. › Emergency room.

How to read your ID card Below is a sample of the Cigna Medicaid-only eligibility ID card. If you have a Medicaid-only eligibility ID card, it will contain important information such as:

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› › › › › Can a specialist beconsidered ever a Primary Care Provider? act can as your choose to a specialist You The must specialist Primary Care Provider. and network Cignabe provider the in a of duties handle the of all agree to Primary Care Provider. Can a clinic Primary be my Care healthProvider? (rural clinic/ health qualified center) federally types of can following choose the you Yes, act Primary as your to Careclinic Provider. child’s Primary Care Provider? times many on how no is limit There can child’s or change your you your can change You Primary Care Provider. calling us toll- Primary by Care Providers 1-877-653-0327free at Cigna Membership Accounting Attention: PO 20012 Box Nashville, 37202 TN Are there reasons any a request why changeto a Primary Care Provider denied? be may Primary change your request to Your can be deniedCare Provider if: How canHow I change Primary my Care MedicareProvider if I receive benefits? coverage Some Members have also may Primary their visits for Care Provider plan. a Medicarethrough If you Advantage STAR+PLUS, and benefits Medicare get Medicare call need your plan to you to Primarychange your Care Provider. manyHow times can I change my/my

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. Please tell the tell . Please , Monday to Friday, 8 a.m. Friday, to , Monday Reminder covered Members STAR+PLUS seeing Medicare keep will by Medicaretheir Primary Care need not to will You Provider. Primarychoose a new Care STAR+PLUS. for Provider 1-877-725-2688 (TTY: 7-1-1) to 5 p.m. 5 Time.to Central if you are looking a Specialist. are for you if through the Service Coordination Team Team Service the through Coordination at (TTY: 7-1-1) to Friday, 8 a.m. 5 p.m. Time. to Central Friday, to Your Primary (PCP) Care Provider Your Your Service Coordinator directly or directly Service Coordinator Your Member Services 1-877-653-0327 at

› › › How canHow I change Primary my When Primary will my Care Provider change effective? become Primary change your ask to CareIf you start change the will on the Provider, after request. the Business The Day Cigna system up the in show change will mail Cigna will 3 Business Days. within 5 Business ID Days card a new within you request. the of The actual delivery time depends U.S. on the Service. Postal Whoever you contact will help you contact will you Whoever If one is an in-network provider. locate other look into Cigna will available, not the receive you sure make to options medically necessary need. services you Care Provider? Primary change your to like would If you can call you Member Care Provider, Services 1-877-653-0327 at representative that you want change to can They Primaryyour Care Provider. Primary choose a new help Care you choose one. need still to you if Provider in your area that offers that medically area the your in necessary need. you services that If a problems locating having are you contact following: the one of provider, If you can’t get your choice of Primary Care All requests are individually reviewed by Provider at the time of enrollment, we will Cigna. You will be told of the decision in assign you to a Primary Care Provider close writing within 10 Days. We will ask you to your home. At other times, a Member to call Member Services to pick a new Services representative can tell you why Primary Care Provider. If you don’t pick a you did not get the Primary Care Provider new Primary Care Provider, Cigna will pick you chose. You can call Member Services one for you. We will write to tell you of the to ask for a different Primary Care Provider change. If your Primary Care Provider no or to ask why you did not get your choice. longer able or willing to be part of Cigna’s provider network, you will be assigned to a new Primary Care Provider. You will get a

Your Primary Care Provider Your Remember new Cigna ID card. If you get a new Primary You should always try to get Care Provider, you will get one that is near care that you need from your your home. The new Primary Care Provider Primary Care Provider first. will be suitable for your age and gender. What if I choose to go to another provider When should I call to make who is not my Primary Care Provider? an appointment? If you want to go to a different provider It is best if you call early in the day in the provider network, the services when you need care. If you wait until are covered. the evening to call your Primary Care Provider, you may not be able to schedule a visit as soon as you want. Please note For STAR+PLUS Members who are What do I need to bring with me covered by Medicare, no Primary to my doctor’s appointment? Care Provider will be assigned. When you go to a doctor’s visit, have lab tests done, go to the emergency room or Tip urgent care center, or receive long-term Always keep your ID cards with you care services, you must bring the following: in a safe, convenient place. Your ID › Your valid Cigna ID card, valid card is important to ensure a quick, picture ID card and either: easy and satisfying experience. – Your Texas Benefits Medicaid Card, or Remember – Your Medicaid temporary verification form (Medicaid Form 1027-A). For most services, you should see the Primary Care Provider you Can my Primary Care Provider picked when you joined Cigna. switch me to another Primary Care Provider for non-compliance? How do I get medical care when my Yes, your Primary Care Provider can ask Primary Care Provider’s office is closed? to switch you to another Primary Care Provider for the following reasons: If you get sick during the evening, › Non-compliance to treatment. weekend or on a holiday you should call your Primary Care Provider at the phone › Failure to call before missing number on the front of your Cigna ID Card. office visits. Your Primary Care Provider is available Failure to follow Primary Care › 24 hours a day, 7 days a week so that you Provider’s advice. can get the help you need. When leaving › Failure to get along with your a voicemail message on a machine, or Primary Care Provider. with an answering service, be sure to: › Threatening behavior. 8 Your Provider Care Primary › Leave a phone number where What is the physician incentive plan? your Primary Care Provider Cigna cannot make payments under a can call you back. physician incentive plan if the payments › Your Primary Care Provider should are designed to induce providers to reduce call you back within 30 minutes. or limit Medically Necessary Covered › If you don’t get a call back, you can Services to Members. You have the right to go to the nearest urgent care center. know if your Primary Care Provider (main › Your Provider Directory has a listing doctor) is part of this physician incentive of urgent care centers and acute plan. You also have a right to know how care hospitals. the plan works. To learn more, call Member › You can also call the 24-Hour Health Services at 1-877-653-0327, Monday to Information Line at 1-855-418-4552. Friday, 8 a.m. to 5 p.m. Central Time. Based on your symptoms, the nurse The incentive plan is designed to provide will recommend care. payments to the Primary Care Provider for meeting certain quality measures. Changing health plans GET THE HELP for SUD, you will not be able to change health plans until you have been discharged. YOU NEED TO When will my health plan change MAKE CHANGES. become effective? What if I want to change health plans? If you call to ask to change your health plan on or before the 15th of the month, You can change your health plan by calling the change will take place on the first the Texas STAR+PLUS program helpline day of the next month. If you call after at . You can change 1-800-964-2777 the 15th of the month, the change will health plans as often as you want. take place the first day of the second If you call to change your health plan month after that. For example: on or before the 15th of the month, › If you call on or before April 15, your the change will take place on the first change will take place on May 1. day of the next month. If you call after › If you call after April 15, your the 15th of the month, the change will change will take place on June 1. take place the first day of the second month after that. For example: Can Cigna ask that I get dropped from their health plan (for non-compliance)? › If you call on or before April 15, your change will take place on May 1. Yes, Cigna can ask the Texas Health and Human Services Commission (HHSC) › If you call after April 15, your change will take place on June 1. to remove you from our health plan for not following the rules when: Who do I call? › Cigna takes reasonable measures To change your health plan, please call to help your behavior through the Texas STAR+PLUS program helpline education and/or counseling, and at 1-800-964-2777. › You continue to refuse to meet the How many times can I change program rules and restrictions. health plans? If the HHSC Disenrollment Committee You can change health plans as often as agrees to remove you, Cigna will help with you want but not more than once a month. the process. If you feel that the HHSC If you are in the hospital, a residential Disenrollment Committee has wrongly Substance Use Disorder (SUD) treatment dropped you, you can ask for an appeal facility, or residential detoxification facility from the Disenrollment Committee. 9 10 Health care benefits InterpretationService services Coordination you. You Coordinator your and Service will: Coordinator will to one assigned be and LTSS, you may still aService request Coordinator.Service you If not receive do youIf receive LTSS, you a are assigned (LTSS) Supports and Services you need. Long Term and you care get the medical ProviderCare other providers and to help your caregiver family or your and Primary Your Coordinator Service works with you, What is Service Coordination? YOU NEED. GET THESUPPORT and covered under your benefit plan. thatyou necessary are medically need You can receive all the covered services of STAR+PLUS. Cigna aMember as that you benefits and receiveservices followingThe list shows the health care benefits? care my health are What AND SERVICES. GET MOREBENEFITS › › › › › › › ›

– – Monitor progress toward toward progress Monitor Coordinate your health needs. care Create plan. acare yourAssess health needs. Behavioral including: health services tests).Audiology (hearing services Ambulance services. 72-hour supplies of your health goals. care emergency prescriptions.

Outpatient mental health health mental Outpatient health mental Inpatient services for adults. for services adults. for services

Member Services at 1-877-653-0327 Services Member Central Youto Time. 5p.m. also call can 1-877-725-2688 Coordinator yourcall Service Cigna at to Coordination the You Service line. can Coordinator’s name and the phone number You will get aletter with your Service Coordinator? aService with Italk How can Coordinator if: Remember to call your Service What will a Service Coordinator do for me? for do Coordinator aService will What › › › › › › › › › › › › › › › ›

– – – – Your caregiver changes. Anything with changes your You are admitted to the hospital. You room. to go the emergency yourHelp caregivers with Help coordinate transportation. Help coordinate doctor’s visits. Make referrals to community resources Durable medical equipment equipment medical Durable provided biologicals and Drugs Disease management programs. Dialysis. services. Chiropractic diagnostic screening, Cancer provided services Birthing by a provided services Birthing by medical condition. medical referrals for support. you help that electricity. get or food can (not associated with benefits) Medicaid and supplies. and inpatient setting. an in services. treatment and center. in alicensed birthing nurse physician or advanced practice a licensed birthing center.

Substance use disorder Counseling services for services. Psychiatry Detoxification services. treatment (see services note). (ageadults older). and 21 , Monday to Friday, 8a.m.

. Health care benefits › Emergency services. – Surgery and reconstruction on › Family planning services. the other breast to produce symmetrical appearance. › Health education related to obesity. – Treatment of physical complications Home health care services, › from the mastectomy and including home tele-monitoring. treatment of lymphedemas. › Hospital services, inpatient – Prophylactic mastectomy to prevent and outpatient. the development of breast cancer. › Inpatient acute. – External breast prosthesis for › Laboratory services. the breast(s) on which medically › Medical checkups and comprehensive necessary mastectomy procedure(s) care program services for children have been performed. birth through age 20 through the › Outpatient acute. Texas Health Steps Program. › Outpatient drugs and biologicals, › Nonemergency Medical including pharmacy dispensed Transportation (NEMT). and provider administered › OB/GYN. outpatient drugs and biologicals. › Optometry, eyeglasses and contact › Outpatient drug programs. lenses, if medically necessary. › Podiatry. › Oral evaluation and fluoride › Prenatal care. varnish in the medical home in Preventive services including conjunction with Texas Health Steps › a yearly wellness checkup for medical checkup for children age Members age 21 and older. 6 months through 35 months. › Primary care services. › Mastectomy, breast reconstruction and related follow up procedures, › Radiology, imaging and x-rays. including outpatient services › Service Coordination. provided at an outpatient hospital › Specialty physician services. and ambulatory health care Telehealth. center as clinically appropriate › and physician and professional › Telemedicine. services provided in an office, › Telemonitoring. inpatient or outpatient setting for: › Transplantation of organs and tissues. – All stages of reconstruction on › Vision, Medicaid-only. the breast(s) on which medically necessary mastectomy procedure(s) have been performed.

NOTE - Substance use disorder treatment services Outpatient services such as: Residential services such as: · Assessment. · Detoxification services. · Detoxification services. · Substance use disorder treatment · Counseling treatment. (including room and board). · Medication-assisted therapy. · Mental health rehabilitative services that reduce a Member’s disability resulting from severe mental illness and serious emotional, behavioral or mental disorders. · Targeted case management services that assist Members with getting access to needed medical, social, educational, and other services and supports.

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Women, Infants and Children Children and Women, Infants aids hearing tests and Hearing Transportation to and from Personal assistance services. services. assistance Personal Day health activity services. and for children. (WIC) services. visits. doctor your health benefits. care covers Medicare Medicaid, youIf receive and Medicare Remember .

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Home-delivered meals. Supported employment service is Employment assistance service Emergency response services. Dental services. services. rehabilitation Cognitive services. living Assisted Adult foster care. Adaptive equipment medical and aids Supported Employment. services. assistance Personal Day Habilitation services. Transitional assistance services. Physical therapy, occupational services. care Respite Protective supervision. modifications. home Minor supplies. Medical nursing services. In-home or her sustain that employment. that sustain employment. her or workers to him non-disabled help employment in asetting that includes provided to paid who has aperson employment in the community. locate paid people helps walkers canes. and wheelchairs, such as therapy, speech therapy. Health care benefits What number do I call to find Who do I call to learn more about CDS? out about these services? To learn more about CDS, call your If you have questions about your Service Coordinator at 1-877-725-2688 LTSS benefits, call your Service or Member Services at 1-877-653-0327. Coordinator at 1-877-725-2688 or Member Services at 1-877-653-0327. Will my STAR+PLUS benefits change if I am in a Nursing Facility? What is Cognitive Rehabilitation No, your benefits are determined by your Therapy (CRT)? eligibility. Please call Cigna Member Services Cognitive Rehabilitation Therapy is a benefit at 1-877-653-0327 for more information. for STAR+PLUS Waiver Members that assists in learning or re-learning cognitive What are my Acute Care benefits? skills that have been lost or altered as Your Acute Care benefits are the same as a result of an acquired brain injury. your health care benefits listed on page 10. How do I get CRT? How do I get these services? The determination to complete the necessary testing will be made by your Your Primary Care Provider can give you Service Coordinator. Call your Service most of the care you need or refer you to Coordinator at 1-877-725-2688 or another provider for specialized care. You Member Services at 1-877-653-0327. can also call your Primary Care Provider and let the office know what service you need. What are Consumer Directed Services and Financial Management Services agencies? What number do I call to find Consumer Directed Services (CDS), out about these services? managed by a Financial Management If you have questions about your Cigna Services (FMS) agency, give you a way benefits, or need help obtaining information that you can have more choice and control about covered services, you can call your over some of the LTSS you get. As a Service Coordinator at 1-877-725-2688 STAR+PLUS Member, you can choose or Member Services at 1-877-653-0327. the CDS option. With CDS, you can: › Find, screen, hire, train and fire What services are not covered? (if needed) the people who Medicaid and/or Cigna don’t provide your services. cover the following services. You can manage the following services: › › Diet programs for the – Attendant care. following purposes: – Cognitive Rehabilitation – Weight loss for its own sake. Therapy (CRT). – Cosmetic purposes. – Nursing. – Psychological dissatisfaction – Occupational therapy. with personal body image. – Physical therapy. – Member or provider – Protective supervision. convenience or preference. – Respite care. › Cosmetic surgery. – Speech therapy. › Experimental services, such as If you choose to be in CDS, you will be treatment that is still being tested or has not been proven yet to work. in contract with an FMS agency. The FMS agency will help you get started › Fertility treatments. and give you training and support if you need it. The FMS agency will do your payroll and file your taxes. 13 14 Health care benefits HHSC will continueHHSC to provide LTSS. throughservices STAR+PLUS Cigna and waiverIDD are eligible for acute care program an or through the ICF-IDD who receive and for Medicare services relatedor conditions not who qualify do withIndividuals intellectual disabilities waiver member? IDD or program IDD ICF- an as for Ieligible am services What Living waiverHome program (TxHmL). waiver the Texas and program (HCS), Services Community-Based and Home Disabilities waiver program (DBMD), the (CLASS), the Deaf-Blind with Multiple waiver Services program Support Community Living Assistance and waiver IDD byThe is supported the waiver? IDD the support programs What than aState-supported living center. in intermediate facilities care other relatedor conditions who receive care individuals with intellectual disabilities program serves This Medicaid (ICF-IDD)Disability program? Developmental and Intellectual Facility- Care Intermediate the is What › › › › › › › › › › ›

Treatment for disabilities Sterilization 21. age under for Members Sex change operations. outside provided Services providedServices to any who person by provided Services by paid Services any other that areServices not Routine foot except care, for Members sterilization. of voluntary Reversal private room, Private hospital associated with military service. military with associated of the United States. inmateis an of jail apublic prison. or providers. non-Medicaid benefits program. health, accident or government medically necessary. with diabetes circulation. poor or items in the hospital. when nursingduty or personal comfort

Medicare Medicaid) and get? Members STAR+PLUSCigna (covered Dual by can Services Value-added What you alreadybenefits get from STAR+PLUS. are in additionValue-added Services to the benefits called Value-added Services. These you of Cigna, get additional aMember As Cigna? of aMember as Iget do benefits extra What the Cigna STAR+PLUS program. are eligible for under all of the benefits underMembers the MBCC program Cancer (MBCC) Member? Cervical and Breast for a Medicaid as for Ieligible am services What › › › › ›

Members who are enrolled in the who are in enrolled the Members 24-Hour Health Information Line. $30 each quarter to quarter use each toward$30 over- that for card Members gift $25 that for card Members $20 gift toward monthly minute allotment. allotment. minute toward monthly that will number not count phone Services tocalls the Member Cigna program will receive outbound free Phone LifelineFederal Smart free but must be used by August 31, 2021. 2021. by used be must but August 31, quarter-to-quarter accumulate may covered Monthly sum by Medicaid. prescription are not and otherwise related items that not require do a (OTC)the-counter health or medicines card per per year. Member to receive Limit 1gift card. gift be an actively enrolled Member Cancer screening. must Member complete a recommended Cervical year. per Member per card 1 gift to receive Limit Member card. gift mustMember be an actively enrolled complete A1C annual an test.

Health care benefits 15 .

. You can call also . You 1-877-725-2688 follow your plan. your follow pressure problems.pressure Hospice services. Develop a plan to get healthier. get a plan to Develop goalsSet along way. the caregivers your all sure Make needs health met. your are all sure Make services. health public Essential Heart, lung and blood Diabetes. Obesity. Kidney disease.

› › › › › › › › › › Your Service Coordinator can provide can Serviceprovide Coordinator Your during education health materials the you or upon request you by with visit their calling How canHow I contact My Personal Health Coach? aboutMy the need If information you more your call program, Coach Health Personal 1-877-725-2688 at Service Coordinator or Member Services 1-877-653-0327 at Coach a Health call you. have Ask to What other services can Cigna help me get? needIf you them, Service your can get help you Coordinator on services offered by information outside Cigna network. the providers This program will help you learn about help you will program This take to learn how will illness. You your part healthier. an getting active in people of who a team have will You doctor: and help your you will What is the “My Personal Health program? Coach” CoachA Cigna Health helps you as: such manage illnesses Member Services 1-877-653-0327 at

. 1-877-653-0327 (CAD) – heart disease. (CAD) Disease (COPD) – lung disease. Disease (COPD) complete an annual physical or an annual physical complete the of any along with visit, wellness screenings or health laboratory tests Good the in Rewards Health shown or on the brochure Program and website member STAR+PLUS Limit provider. the recommended by 1 gift card per Member per year. 21 years and older: An eye exam, a exam, and21 older: years An eye and an additional eyeglasses pair of $100 up to of enhanced for allowance frame months. 12 selection every apply not does $100 allowance contact lenses,to add-ons (tints, AR, coatings, replacement etc.), sunglasses. or eyewear $500 each year for checkups, x-rays, $500 checkups, for each year x-rays, cleanings, fillings and simple tooth Members for extractions 21 and older. Kidney disease. Congestive Heart Failure (CHF). HeartCongestive Failure problems. breathing Asthma Artery Coronary Disease Chronic Obstructive Pulmonary Obstructive Chronic Diabetes – high blood – high sugar. Diabetes $30 gift Members card for that Extra vision benefitsExtra Members vision for Extra dental services adults: for Up to

› › › › › › › › › How canHow I get these benefits? learn about more benefits, please call To at Services Member What health education classes does Cigna offer? Cigna offers Member individual and education health classes caregiver subjects.on following the What Value-added Services can Cigna Medicaid-only Members get? STAR+PLUS Services Value-added Dual of for All Members plus: 16 Nonemergency Medical Transportation (NEMT) Eye care Health care benefits FOR YOUR EYES. TO HELPCARE LOOK TO US What services are part of NEMT? NEMT? of part are services What do NOT include ambulance trips. trips These services. you get Medicaid hospital, pharmacy, and other places rides toinclude the doctor, dentist, transportation options. These trips who havefor members other no nonemergency health care appointments provide services NEMT to transportation Services? NEMT are What TRANSPORTATION. TO HELPWITH DEPEND ONUS › › › › › › › › › ›

Women, Infants and Children Children and Women, Infants provided Tuberculosis services Texas Health Steps Medical Texas Health Steps services. Dental Texas for Commission the Texas agency-administered programs related health and School services. Pregnant women and infants Commercial airline airline Commercial cities states, by or including rail bus. or transit mass as within between and ticketsPasses or for such transportation (WIC) nutrition(WIC) program. providers. HHSC-approved by case management. Blind case management. and case management services. case management. transportation services. transportation

at at eye by Vision services care Superior calling get routine with only can Medicaid Members eye Iget services? How do care program include, but are but not limitedprogram include, to: not coveredservices by the STAR+PLUS getting community resources. Community Coordinator yourask Service for help explorecan your on own. You also can resources community about that you Youprogram. for ask information can not coveredservices by the STAR+PLUS community resources that provide Cigna members staff know about covered resources? community non- get me help Cigna Can specialty eyespecialty ophthalmologist. from an care You first. help areferral not for need do eye, Provider Care your call for Primary eye to your for illnessinjury care or an Central you If to Time. need 8p.m. 7 a.m. › › › › › › 1-888-886-1995

the nearest emergency room. emergency the nearest 9-1-1 directly call go or toothers, threatens of the life property or emergency or an emergency that youIf have alife-threatening Please remember Childcare programs. Utility assistance. Housing assistance. If youIf are 20years younger, or old for individual an reimbursement Mileage Demand response transportation distance tripdistance to obtain health care of associated meals with along- you may to able be receive the cost member, aneighbor. or afriend, you, be aresponsible party, afamily ITP enrolled The can service. healthcare verified completed trip to a covered (ITP) participant transportation for a accessible if vans, necessary. wheelchair- including sedans, or intransportation private vans, buses, curb-to-curb is which services, , Monday to Friday,

Nonemergency Medical Transportation Medical Nonemergency (NEMT) services. The daily rate for meals is guardian, or other authorized adults $25 per day for the member and $25 on file to travel alone. Parental consent per day for an approved attendant. is not required if the health care › If you are 20 years old or younger, service is confidential in nature. you may be able to receive the Who do I call for a ride to a medical cost of lodging associated with a appointment? long-distance trip to obtain health To schedule a ride call Access2Care at care services. Lodging services are 1-888-721-8184, Monday to Friday, 8 a.m. limited to the overnight stay and to 5 p.m. Central Time, excluding State do not include any amenities used approved holidays. You should request during your stay, such as phone calls, NEMT Services as early as possible, and at room service, or laundry service. least two Business Days before you need If you are 20 years old or younger, › the NEMT service. In certain circumstances you may be able to receive funds you may request the NEMT service with less in advance of a trip to cover authorized NEMT services. notice. These circumstances include being picked up after being discharged from a If you need an attendant to travel to › hospital; trips to the pharmacy to pick up your appointment with you, NEMT services will cover the transportation medication or approved medical supplies; costs of your attendant. and trips for urgent conditions. An urgent condition is a health condition that is not an › Children 14 years old and younger must emergency but is severe or painful enough be accompanied by a parent, guardian, or other authorized adult. Children 15-17 to require treatment within 24 hours. Prescription drugs and pharmacy benefits pharmacy and Prescription drugs years old must be accompanied by a You must notify Cigna prior to the parent, guardian, or other authorized approved and scheduled trip if your adult or have consent from a parent, medical appointment is cancelled.

GET HELP WITH How do I find a network drug store? If you need help finding a Medicaid YOUR PRESCRIPTIONS. Pharmacy, call Member Services at 1-877-653-0327. We will help you What are my prescription drug benefits? find a pharmacy close to you. Cigna is responsible for prescription drug coverage. The Prescription Drug Program What if I go to a drug store not in does not limit the number of prescriptions the network? allowed each month for Medicaid- You have to go to a Cigna pharmacy. only Members enrolled in STAR+PLUS. Call us if you are out of state and need If you have concerns related to your emergency prescriptions. We can help prescriptions, Cigna can help you with you find a network pharmacy. Call questions regarding your Prescription Drug Member Services at 1-877-653-0327. Program benefit. You can call Member What do I bring with me to the drug store? Services at 1-877-653-0327 for questions regarding prescription drugs or visit When you go to the pharmacy, you should bring: starplus.cigna.com/members/pharmacy. › Your Cigna ID card. How do I get my medications? › Your Texas benefits ID card. Medicaid pays for most medicine your › The original, signed prescription doctor says you need. Your doctor will your doctor gave you. write a prescription so you can take If you are refilling your prescription, it to the drug store, or may be able or if your doctor’s office faxed your to send the prescription for you. prescription to the pharmacy, you will only need your ID cards. 17 18 Prescription drugs and pharmacy benefits include medications taken medications toinclude with help early filled be thatMedications can early? to fill request may I medications Which days. different the on medications are having and medications, to refill may if you helpful be are many taking at store the drug time. This at the same to used be you help fill your medications storedrug before their refill date. This can by filled be can your medications Some What is Medication Synchronization? at 1-877-653-0327 Services Member Call prescriptions. refill early to They us ask from can us. give They get authorization can Cigna. call Your we help. stolen, can can pharmacy yourIf prescription is medication lost or my Ilose medications? if What your refills. and medications 1-877-653-0327 at Services Member Cigna Call supply of your medication. toable get athree-day emergency approve aprescription, you may be to reached be yourIf cannot doctor my doctor ordered approved? medication the get Ican’t if What Central to Time. 5p.m. 8 a.m. 1-877-653-0327 You at Services Member call can getting my medications? Ihave if problems Icall do Who delivery. To 1-877-653-0327 call more, learn pharmacy unless you ask for mail order retail community fromdelivery aqualified is not asubstitute and delivery order for This is in addition area. delivery to mail retail in the service community pharmacies outpatient pharmaceutical deliveries from STAR+PLUS will make sure that you get free for pharmaceutical delivery services. Cigna pays retail community qualified pharmacies Prescription Medicaid The Program Drug to me?delivered my medications Ineed if What , Monday to Friday, for help with with help for for help. . (TTY: 7-1-1) (TTY: at Cigna also 1-877-653-0327 call can You, your pharmacist, or your doctor fill the for medication you. can she he/sheIf so will doing feels safe, he/ be that filling your early medication is safe. so. Yourdo will pharmacist make sure early, you your ask to can pharmacist youIf would like to fill amedication early? medication a to fill Irequest How can pressure, high diabetes. cholesterol, and illnesses high such as blood certain meet anymeet of the below requirements. (up month) to per 2cans/bottles if you paysMedicaid for mosquito repellent spray spray to prevent Zika virus? repellent mosquito Iget How do for more information these benefits. about 1-877-653-0327 Call minerals. vitamins and some and formula, diapers, counter drugs, prescribed over-the- necessary medically through 20,also Cigna birth pays age for necessary.are For medically children, covered if they equipment supplies and nebulizers, ostomy other and supplies, are covered pays Cigna by for Medicaid. and products normally found in a pharmacy Equipment (DME) Medical Durable Some normally found in a pharmacy? products other or (DME) Equipment Medical Durable Ineed if What at 1-877-653-0327 Services Member additional call assistance please need administering you If your medications. Facility Nursing The may assist in staff Facility? aNursing in I am if my Iget medications How do coverage. yourchange Medicare insurance to STAR+PLUS use. will not is alwaysthat Medicare the first coverage. your primary This means STAR+PLUS, will your Medicare be youIf have in addition to Medicare have Ialso if Medicare? What Centralto Time. 5p.m. , Monday to Friday, 8a.m. .

pharmacy benefits pharmacy and Prescription drugs › Female age 10–55 years old. What is the Medicaid Lock-In Program? › Male age 14 and older. You may be put in the Lock-In program › Pregnant. if you do not follow Medicaid rules. It You can get mosquito repellent spray checks how you use Medicaid pharmacy from any network pharmacy. If you need services. Your Medicaid benefits remain help finding a network pharmacy, call the same. Changing to a different MCO will not change the Lock-In status. Member Services at 1-877-653-0327. You do not need a prescription from your To avoid being put in the Medicaid doctor in order to get mosquito repellent Lock-In program: spray from your pharmacy. However, if › Pick one pharmacy at one your pharmacy recommends getting a location to use all the time. prescription, you can call your Primary › Be sure your main doctor, main Care Provider’s office and request that dentist, or the specialists they they send the pharmacy a prescription. refer you to are the only doctors For more information, please visit that give you prescriptions. starplus.cigna.com. › Do not get the same type of medicine from different doctors. To learn more call Cigna Member Services at 1-877-653-0327. UNDERSTAND BEHAVIORAL HEALTH. What are behavioral health services? Do I need a referral for this? Behavioral health refers to the care No, a referral from your Primary Care and treatment of Members with: Provider is not necessary to receive mental Behavioral health › Mental health concerns. health and substance abuse services. › Drugs or alcohol dependence. What are mental health rehabilitative services and mental health How do I get help if I have behavioral targeted case management? (mental) health, alcohol or drug problems? › Mental health rehabilitative For routine help, call the behavioral services are services that may health line at 1-877-725-2539. Cigna help reduce a Member’s disability covers medically necessary substance resulting from severe mental abuse and behavioral health care. illness or serious emotional, behavioral or mental disorders. How do I get emergency help for mental › Targeted Case Management are health or substance abuse issues? services that assist Members with If you have a mental health crisis, you getting access to needed medical, can get help by calling the mental social, educational, and other services health crisis line at 1-800-959-4941. and supports. These services help Qualified mental health professionals the member maintain independence are ready 24 hours a day to: in the home and community. › Answer your questions. Assess your mental health. › Attention › Provide and coordinate services you need. If you have a life-threatening emergency or an emergency that › Speak with you in English or Spanish. poses a threat to the life or property › Speak with you in other of others, call 9-1-1 or go directly languages when you ask. to the nearest emergency room.

19 20 Family planning Behavioral health abuse services are offered: services abuse followingThe outpatient substance services available? are abuse substance What outpatient services available? are What behavioral health at 1-877-653-0327 Services Member at or 1-877-725-2539 Manager Case To your call more, Behavioral learn Health services? these Iget How do Provider to services. get family planning to Care you need your ask No, don’t Primary this? for areferral Ineed Do 1-877-653-0327 Please call you need. We you the help care find Medicaid. can any family planning provider who takes that fit the way you live. You to go can services family planning Program offers Healthy The Texasthese services. Women Providerto Care your ask to Primary get counseling are private. You need don’t control birth such as services planning and older, you and If are 18 age family services? planning family Iget How do YOUR PRIVACY. WE RESPECT KNOW THAT › › › › › › › › › ›

Assessment. Assessment. therapy. Electroconvulsive services. observation Stabilization and crisis interventionMobile services. Residential care. hospitalization services. Partial Inpatient psychiatric hospitalization. Outpatient with services alicensed coordination and Planning of Education over the phone worker and counselor. psychiatrist, psychologist, social services. health behavioral or face-to-face.

. . at at Services theIf answer is “no,” Member call anything. do to have theIf answer is “yes,” you don’t providerCigna for the STAR+PLUS program. your health provider mental if they are a youIf are already getting treatment, ask treatment? in already Iam if What to your total manage health care. twoThese professionals will work together your to condition. manage help Manager you also have can aBehavioral Health Case you also have abehavioral health condition, to your If total manage health needs. care You will have Coordinator Service aCigna Manager? Case What is a Behavioral Health finding a family planning provider. afamily planning finding at Cigna 1-877-653-0327 call services/family-planning services-providers/womens-health- business-hhs/provider-portals/health- atonline https://hhs.texas.gov/doing- providers services you planning near You the locations of find family can servicesplanning provider? afamily Ifind do Where the local mental health authority health authority mental the local Yes. You keep getting from care can provider? care health mybe behavioral clinic authority health mental alocal Can › › › 1-877-653-0327

Medication-assisted therapy. Counseling treatment. Detoxification. at at Cigna you Call are all alone. You never should like feel P.S. 1-877-653-0327 to aprovider. find for help. or you can you or can for help

OB/GYN care MAKE CHOICES THAT MEET YOUR INDIVIDUAL NEEDS.

ATTENTION FEMALE MEMBERS

What if I need OB/GYN care? Will I need a referral? Cigna allows you to pick an OB/GYN No. You will not need a referral but this doctor must be in the same to see your OB/GYN. network as your Primary Care Provider. You have the right to pick an OB/GYN How soon can I be seen after contacting without a referral from your Primary Care my OB/GYN for an appointment? Provider. An OB/GYN can give you: You can be seen within 14 Days. If you › One well-woman checkup each year. have problems scheduling a visit within 14 Days, please call Member Services › Care related to pregnancy. at 1-877-653-0327. › Care for any female medical condition. › Referral to a special doctor Can I stay with my OB/GYN within the network. if they are not with Cigna? You can also receive these services from Your OB/GYN should be a part of the Cigna your Primary Care Provider. Ask your provider network. However, if your current Primary Care Provider if he or she can give OB/GYN is not in the network and you are: you OB/GYN care. You can call Member Services for help in choosing an OB/GYN. If › Pregnant with less than 12 weeks until your due date: you have Medicare coverage, you don’t have to pick an OB/GYN in the Cigna network. – You can keep going to see your current OB/GYN through your postpartum checkup. Do I have the right to choose an OB/GYN? – Your current OB/GYN needs to Yes. You have the right to choose call Cigna for authorization. an OB/GYN. › Pregnant with more than 12 weeks until your due date: How do I choose an OB/GYN? – You need to pick an OB/GYN from You can get help choosing an the Cigna network of providers. OB/GYN in these ways: To learn more, call Member Services at › Pick an OB/GYN from the 1-877-653-0327 or your Service Cigna provider directory. Coordinator at 1-877-725-2688. › Ask your Primary Care Provider to help you pick an OB/GYN. › Call Member Services to ask for help in choosing an OB/GYN.

If I do not choose an OB/GYN, do I have direct access? Keep in mind Yes. To learn more, call Member We handle all matters with Services at 1-877-653-0327. confidence and focus on protecting your private information.

21 22 Prenatal and pregnancy care Monday to Friday, Central to 8p.m. 8a.m. STAR+PLUS at 1-800-964-2777 Helpline your the After call please baby is born, Provider? Care Primary baby’s my Iswitch can when How and at 1-877-653-0327 Services Member call beforein our of the birth your baby. Please you to are able is doctor if see aparticular is in enrolled atimely manner. However, Central toto Time, ensure your 8p.m. baby 1-800-964-2777 the STAR+PLUScontact at Helpline information from the State. Please Provider prior to receiving your baby’s We to Care are unable assign aPrimary born? baby is the my baby before for Provider Care aPrimary Ipick Can at 1-877-653-0327 Services To center, abirthing find Member call centers? birthing of alist Ifind can Where works with Provider. Care your Primary Your plan. prenatal care Coordinator Service they and you help follow support, and your They providecomplex needs. education Coordinators work closely with with mothers youhelp your after Service baby is born. yourduring pregnancy. They will also Your Coordinator Service will you help women? pregnant offer Cigna does services/activities/education other What at 1-877-653-0327 Services Member call you as you soon out find As are pregnant, to call? Ineed do Who fora doctor you your and newborn. pregnancy. We you also help find can to you care withand need help your We you help get the can information pregnant? Iam if What YOUR PREGNANCY. EVERY STAGE OF GET HELPAT , Monday to Friday, 8 a.m.

. . , Fax: (toll-free) 1-866-993-9971 Website: (toll-free)Phone: 1-866-993-9972 78714-9021 TX Austin, Box 149021 PO Healthy Texas Women Program write, visit or call, the program’s website: through the Healthy Texas Women Program, To available services more about learn throughget services this program. applicationan to if out you find can poverty level).federal You submit must percent of the limitsincome (185 isincome at below or the program’s to whose household 18 women 44 ages control birth health and screenings to provides family planning exams, related HealthyThe Texas Women Program Healthy Texas Women Program are approved. for and apply the services are(DSHS). for services women These who of State the Department Health Services the Healthy Texas Women Program and through health services get care some coverage.Medicaid You may to able be yourAfter you baby may is born, lose covered by Medicaid? longer no Iam if my born baby is after care Ireceive health How can Coordinator at 1-877-725-2688 Youbaby is born. your call Service can sign your up and baby your after soon to tellIt is important your health plan plan? my Itell health do when How and To how learn to sign your up baby, 2-1-1 call baby? my up newborn Isign How do ProviderCare until the baby is 3months old. you cannot change your baby’s Primary your Provider,selected baby’s Care Primary Provider. Care Primary you Once have at 1-877-653-0327 Services number, ID Member call a Medicaid please toTime, enroll your baby. you Once have www.healthytexaswomen.org

to select a to a select .

. Prenatal and pregnancy care pregnancy and Prenatal DSHS Primary Health Care Program DSHS Expanded Primary The DSHS Primary Health Care Program Health Care Program serves women, children, and men who The Expanded Primary Health Care are unable to access the same care Program provides primary, preventive, through insurance or other programs. and screening services to women age 18 To get services through this program, a and above whose income is at or below person’s income must be at or below the the program’s income limits (200 percent program’s income limits (200 percent of the federal poverty level). Outreach of the federal poverty level). A person and direct services are provided through approved for services may have to pay a community clinics under contract with co-payment, but no one is turned down DSHS. Community health workers will for services because of a lack of money. help make sure women get the preventive The Primary Health Care Program focuses and screening services they need. Some on prevention of disease, early detection clinics may offer help with breast feeding. and early intervention of health problems. You can apply for these services at certain The main services provided are: clinics in your area. To find a clinic where › Diagnosis and treatment. you can apply, visit the DSHS Family and Community Health Services Clinic Locator Emergency services. › at http://txclinics.dshs.texas.gov/chcl/. Family planning. › To learn more about services you › Preventive health services, including can get through the DSHS Expanded vaccines (shots) and health Primary Health Care Program, visit the education, as well as laboratory, program’s website, call, or email: x-ray, nuclear medicine or other appropriate diagnostic services. Website: https://hhs.texas.gov/services/health/ Secondary services that may be provided primary-health-care-services-program are nutrition services, health screening, Phone: 512-776-5922 home health care, dental care, rides to Fax: 512-776-7264 medical visits, medicines your doctor Email: [email protected] orders (prescription drugs), durable medical supplies, environmental health DSHS Family Planning Program services, treatment of damaged feet (podiatry services), and social services. The Family Planning Program has clinic sites across the State that provide quality, You will be able to apply for Primary low-cost, and easy-to-use birth control for Health Care Program services at certain women and men. clinics in your area. To find a clinic where you can apply, visit the DSHS Family and To find a clinic in your area visit the Community Health Services Clinic Locator DSHS Family and Community Health at http://txclinics.dshs.texas.gov/chcl/. Services Clinic Locator at http:// txclinics.dshs.texas.gov/chcl/. To learn more about services you can get through the Primary Health Care Program, To learn more about services you can get email, call, or visit the program’s website: through the Family Planning Program, visit the program’s website, call, or email: Website: https://hhs.texas.gov/services/health/ Website: https://www.healthytexaswomen. primary-health-care-services-program org/healthcare-programs/ Phone: 512-776-5922 family-planning-program Email: [email protected] Phone: 1-866-993-9972 Email: [email protected] How and when do I tell my caseworker? Call your Cigna Service Coordinator at 1-877-725-2688. They will help you inform your caseworker.

23 24 Case management for children and pregnant women Medicaid and: and: Medicaid 20)age women pregnant who get and young through (birth teens, adults Children, manager? acase get can Who to you. help manager You to might able be get acase Need help findingservices? getting and and Pregnant Women (CPW) for Children Case Management YOUR FAMILY. GET HELPFORGROWING A case manager will visit manager A case with you then: and do? managers case do What › › › › › ›

Teach you how to and find where you near live.Find services you whatFind out services need. Are at ahigh risk for getting Have or health problems, Make sure you are getting get other services. health problems. the services youthe services need.

https://citysearch.hhsc.state.tx.us/ You to go can provider? ECI an Ifind do Where ECI at any time, even early as birth. as referred be Achild can milestones. to has missed important developmental to areparents the first notice if their child –mayfriends make areferral. often, Most caregivers,members, teachers, doctors or Anyone involved with the child –family a doctor’s referral to access ECI services. You diagnosis or amedical not need do this? for areferral Ineed Do toddlers age. of or babies the same developing pace other as at the same to seem be don’t or disability diagnosed to children who help have amedically State-wide program that families supports InterventionEarly Childhood (ECI) is a What is Early Childhood Intervention? togo www.dshs.state.tx.us/caseman Friday, To to 8p.m. 8a.m. more, learn 1-877-847-8377 the TexasCall Health Steps at manager? you acase get How can Case managers can help you: you: help can managers Case you get? can help of kind What

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GET HELP EVERY STEP OF THE WAY.

What is Texas Health Steps? If the doctor or dentist finds a health Texas Health Steps offers regular medical, problem during a checkup, your child can dental and vision checkups. It also offers get the care he or she needs, such as: vaccines to infants, children, teens, and › Eye tests and eyeglasses. young adults birth through age 20. Texas › Hearing tests and hearing aids. Health Steps helps to: › Dental care. Find and treat your child’s health, › › Other health care. dental and vision problems early. Treatment for other medical conditions. › Make sure your child gets › his or her vaccines. Call Cigna at 1-877-653-0327 or Texas › Give you health education to Health Steps toll-free at 1-877-847-8377 keep your child healthy. (1-877-THSTEPS) if you: › Help you find a case manager. › Need help finding a doctor or dentist. › Need help setting up a checkup. What services are offered by › Have questions about checkups Texas Health Steps? or Texas Health Steps. Texas Health Steps is the Medicaid health › Need help finding and care program for children, teens and getting other services. young adults, birth through age 20. If you can’t get your child to the Texas Health Steps gives your child: checkup, Medicaid may be able to help. › Free regular medical checkups Children with Medicaid and their parent starting at birth. can get free rides to and from the › Free dental checkups starting doctor, dentist, hospital or drug store. at 6 months of age. Contact Cigna for more information. › A case manager who can find out what services your child needs and How and when do I get Texas Health Steps where to get these services. medical and dental checkups for my child? Texas Health Steps checkups: Regular medical checkups help make sure › Find health problems before they that your child grows up healthier. You get worse and are harder to treat. should take your child to their Primary Care › Prevent health problems that Provider or another Cigna Texas Health make it hard for children to learn Steps provider for their medical checkups. and grow like others their age. › Help your child have a healthy smile. When to set up a checkup: › You will get a letter from Texas Health Steps telling you when it’s time for a checkup. › Call your child’s doctor or dentist to set up the checkup at a time that works best for your family.

25 Your child should get medical › Fluoride treatments to checkups at the following ages. prevent tooth decay. › Other services as needed. 3‑5 days old 2 weeks old 2 months old Remember First year 4 months old Ask your dentist about dental 6 months old

Texas Health Steps Texas 9 months old sealants for your child. A dental 12 months old sealant is a clear plastic material that can help prevent tooth decay. 15 months old 18 months old Second year 2 years old Does my doctor have to be part 2‑1/2 years old of the Cigna network? 3 years old Yes. Your child can go to any Texas Health 4 years old Steps Medicaid provider for Texas Health 5 years old Steps services. Most Cigna Primary Care Third year 6 years old Providers who treat children can offer Texas and after 7 years old Health Steps services. You can talk to your 8 years old and every child’s Primary Care Provider first. Be sure year until aged 20 to show your Cigna ID Card and your Texas Benefits Medicaid Card to the provider. Your child should get regular dental checkups to ensure healthy teeth and gums. Do I have to have a referral? Dental checkups need to start at age 6 months and keep going every 6 months No, you don’t need a referral for Texas after that. You can get these services by Health Steps services for your child. calling your child’s Primary Care Provider You should talk to your Primary Care or main dentist to schedule a visit. Tell the Provider if you plan to go to a non-Cigna person on the phone that you want to provider for services. Cigna pays for schedule a Texas Health Steps checkup. services provided by network doctors. The first checkup should be set up within 45 Days of your child joining the health plan. What if I need to cancel an appointment? You should call your Texas Health Steps What dental services does Texas doctor or dentist as soon as you know that Health Steps offer for my child? you need to cancel a visit. When you call, Your child can go to any Texas Health Steps be sure to schedule a new time for your dentist for a dental checkup. You don’t need child’s visit. Many providers want you to a referral from your Primary Care Provider call 24 hours before the scheduled visit. for regular dental checkups, emergency dental care or other dental services. What if I am out of town and my child is due for a Texas Health Steps checkup? Dental services include: When you return, set up a checkup as Routine dental checkup › soon as you can. It is very important every 6 months. that your child get these services. › Fixing tooth decay. › Cleaning of teeth What if I am a migrant farmworker? (as often as every 6 months). You can get your checkup sooner › Braces (except for cosmetic reasons). if you are leaving the area. › Emergency dental care. › X-rays as needed. 26 Child’s dental care Where to go when you need care 27

not primarily for the convenience convenience the for primarily not Member the andof or provider; provided at appropriate facilities facilities appropriate at provided levels appropriate the at and a of treatment the care for of Member’s conditions; health diagnoses the with consistent of the conditions; illnesses or medicalillnesses or conditions, provide early screening, interventions, that conditions for or treatments cause suffering or pain, cause in or deformity limitations physical cause or worsen to function, threaten a handicap, cause or illness infirmity or endanger a Member, life; of reasonable and necessary to prevent reasonable and necessary prevent to no more intrusive or restrictive than or restrictive no intrusive more balance proper a provide to necessary effectiveness,of safety, and efficiency; consistent with health care practice health with consistent that standards and guidelines professionally by endorsed are organizations care health recognized agencies; governmental or not experimental or investigative; and or investigative; experimental not For Members over age Members non- 20, For over behavioral health-related health are: care services that (b) (b) (c) (d) (e) (f) (g) (a) (a) Cigna covers hospital, physician, and hospital, physician, Cigna covers medical above services the related for includes This conditions. services doctor the child and services other your provides need, anesthesia drugs.might or other like paying for responsible also Cigna is for and devices treatment for anomalies. craniofacial Medicaid child’s dental plan provides Your dental other servicesall including services and decay services tooth help prevent that dental fix problems.that Call child’s your Medicaid learn more dental plan to offer. about dental the services they (2) (2)

means: may include consideration of include consideration may factors, as such the relevant other described in partscriteria (2)(b-g) definition. and this (3)(b-g) of must comply with the must with comply Alberto the requirements of al. partial et Traylor, N., al. v. et and agreements; settlement other Health Care Health other Services, including Services Health areBehavioral that anecessary or correct ameliorate to or mental illnessdefect or physical of A determination or condition. a servicewhether necessary is to a defect or orcorrect ameliorate or mental or illness condition: physical screening, vision, and hearing services; and (ii) (ii) (i) (i) of tooth or gum origin. tooth of teeth and structures. supporting teeth Removal of cysts. of Removal oral abscess of Treatment Treatment of dislocated jaw. jaw. dislocated of Treatment damage to traumatic of Treatment For Members,For age birth the 20, through services: Steps Health Texas following

(a) (a) (b) › › › › (1) What does medically necessary mean? necessary Medically UNDERSTAND UNDERSTAND COVERAGE. YOUR SMILE HEALTHY. HEALTHY. SMILE What dental services does for children?Cigna cover dental emergency covers Cigna services or ambulatory a hospital in including, but not surgical center, following: the for payment to, limited KEEP YOUR CHILD’S YOUR KEEP (3) For Members over age 20, What is urgent medical care? behavioral health services that: Another type of care is urgent care. There (a) are reasonable and necessary for the are some injuries and illnesses that are diagnosis or treatment of a mental probably not emergencies but can turn health or chemical dependency into emergencies if they are not treated disorder, or to improve, maintain, or within 24 hours. Some examples are: prevent deterioration of functioning › Minor burns or cuts. resulting from such a disorder; › Earaches. (b) are in accordance with professionally › Sore throats. accepted clinical guidelines and › Muscle sprains and strains. standards of practice in behavioral health care; What is an urgent care clinic? (c) are furnished in the most appropriate

Where to go when you needWhere care go to when you An urgent care clinic is an office-based and least restrictive setting in which practice that meets urgent care needs. services can be safely provided; An urgent care clinic is available when (d) are the most appropriate level or your Primary Care Provider may not supply of service that can safely be available, such as after-hours or be provided; during weekends and holidays. Some (e) could not be omitted without multispecialty clinics offer this service. adversely affecting the Member’s mental and/or physical health or What should I do if my child or I the quality of care rendered; need urgent medical care? (f) are not experimental or For urgent care, you should call your investigative; and Primary Care Provider’s office even on nights and weekends. Your Primary Care (g) are not primarily for the convenience Provider will tell you what to do. In some of the Member or provider. cases, your Primary Care Provider may tell you to go to an urgent care clinic. If your What is routine medical care? Primary Care Provider tells you to go to an Routine medical care is: urgent care clinic, you don’t need to call › The treatment of most minor the clinic before going. You need to go illnesses and injuries. to a clinic that takes Cigna Medicaid. For › Regular medical checkups. help, call us toll-free at 1-877-653-0327. You also can call our 24-Hour Health When you need routine medical care, you Information Line at 1-855-418-4552 should call your Primary Care Provider to for help getting the care you need. schedule a visit. Your Primary Care Provider will treat you or tell you if you should see another type of doctor, such as a heart How soon can I expect to be seen? doctor, bone doctor or cancer doctor. You should be able to see your Primary Care Provider within 24 hours for an How soon can I expect to be seen? urgent care appointment. If your Primary Care Provider tells you to go to an urgent When your Primary Care Provider is care clinic, you do not need to call the called for routine medical care, they can clinic before going. The urgent care schedule a visit within 14 Days. If you clinic must accept Cigna Medicaid. have problems scheduling a doctor’s visit within 14 Days of request, please call your Service Coordinator at 1-877-725-2688.

28 Where to go when you towhen go care Where need Emergency Services and Emergency Care means: Covered inpatient and outpatient services furnished by a provider that is qualified to furnish such services and Talk to a nurse day or night. that are needed to evaluate or stabilize Call one of the skilled nurses at our an Emergency Medical Condition or 24-Hour Health Information Line. Emergency Behavioral Health Condition, They are trained to help you make including post-stabilization care services. the right choice. How soon can I expect to be seen? Getting emergency room care depends What is emergency medical care? on how serious your condition is when you arrive. If the emergency room doctor thinks Emergency medical care is provided you can be treated outside the emergency for Emergency Medical Conditions and room, you may need to go to your Primary Emergency Behavioral Health Conditions. Care Provider or an urgent care center. You Emergency Medical Condition means: should be seen as soon as possible in an emergency. If you wait over 30 minutes or A medical condition manifesting itself your condition worsens, tell the front desk by acute symptoms of recent onset staff. The hospital staff will decide how and sufficient severity (including severe quickly you need to be seen. Emergency pain), such that a prudent layperson, services must be provided when you arrive who possesses an average knowledge of at the service delivery site, including at health and medicine, could reasonably non-network and out-of-area facilities. expect the absence of immediate medical care could result in: Do I need a prior authorization? 1. placing the patient’s health You do not need a prior authorization in serious jeopardy; for emergency medical care. 2. serious impairment to bodily functions; 3. serious dysfunction of any Are emergency dental services bodily organ or part; covered by the health plan? 4. serious disfigurement; or Cigna covers limited emergency dental 5. in the case of a pregnant women, services in a hospital or ambulatory surgical serious jeopardy to the health of center, including payment for the following: a woman or her unborn child. › Treatment for dislocated jaw. Emergency Behavioral Health › Treatment for traumatic damage to teeth and supporting structures. Condition means: › Removal of cysts. Any condition, without regard to the nature Treatment of oral abscess or cause of the condition, which in the › of tooth or gum origin. opinion of a prudent layperson, possessing average knowledge of medicine and health: › Hospital, physician and related medical services such as drugs for 1. requires immediate intervention or any of the above conditions. medical attention without which the Member would present an immediate What do I do if my child needs danger to themselves or others; or emergency dental care? 2. which renders the Member During normal business hours, call your incapable of controlling, child’s main dentist to find out how to get knowing, or understanding the emergency services. If your child needs consequences of their actions. emergency dental services after the main 29 dentist’s office has closed, call us toll- condition, but no later than 30 Days after free at 1-877-653-0327 or call 9-1-1. request if a referral is required. Always ask your Primary Care Provider if you need What is post-stabilization? a referral to get the services you need. Post-stabilization care services are services covered by Medicaid that How soon can I expect to be seen keep your condition stable following by a specialist? emergency medical care. Cigna specialists will schedule a visit with you as shown below. What if I get sick when I am out of town If you have had an emergency or traveling? › room visit, the specialist doctor If you need medical care when traveling, may see you immediately. call us toll-free at 1-877-653-0327 and › If you have an urgent health care we will help you find a doctor. If you

Where to go when you needWhere care go to when you need, the specialist doctor will see need emergency services while traveling, you within 24 hours of your request. go to a nearby hospital and then call › If you have a routine health care need, us toll-free at 1-877-653-0327. the specialist doctor will see you within 30 Days of your request for a referral What if I am out of the state? from your Primary Care Provider, If you need medical care when traveling, if a referral is required. Routine show the provider you visit your Texas specialty care must be provided Medicaid card and Cigna ID card and within 60 Days of authorization, ask the provider to call us to request an if authorization is required. authorization. If you have questions, you can What services do not need a referral? call Member Services at 1-877-653-0327. If you need emergency care, go to a nearby You should always call your Primary hospital and then call the number above. Care Provider to find out if the services you need require a referral. What if I am out of the country? You don’t need a referral for: Medical services performed out of the › Behavioral health. country are not covered by Medicaid. › OB/GYN. What if I need to see a special › Family planning. doctor (specialist)? How can I ask for a second opinion? A specialist is a doctor who treats specific You can get a second opinion about the health problems, such as a heart doctor, use of any health care services. You can a skin doctor or a bone doctor. Your get a second opinion from a network Primary Care Provider can help you provider or from a non-network provider decide when you need to see a specialist. (if a network provider is not available). You can see a Cigna OB/GYN, eye There is no cost for a second opinion. If doctor, dentist, mental health provider you need help finding a network provider or get family planning services without for care or a second opinion, you can call: talking to your Primary Care Provider. › Your Primary Care Provider. What is a referral? › Your Service Coordinator A referral may be needed from your Primary at 1-877-725-2688. Care Provider to get some services. Your › Cigna Member Services Primary Care Provider must provide routine at 1-877-653-0327. specialty care referrals on a timely basis, based on the urgency of your medical

30 Special needs and advance directives GET HELP MAKING TOUGH DECISIONS.

Who do I call if I have special health care What are advance directives? needs and need someone to help me? Advance directives are You can call your Service Coordinator to documents that state: get help with special health care needs. We › What kind of treatment you can tell you about services and resources want or don’t want. to meet your needs. It is important to › What actions you want carried out tell your Primary Care Provider that you if you become too sick to make have special needs. The best way to tell decisions about your care. your Primary Care Provider about your › Who should make health care special needs is during your doctor’s decisions for you if you are too visit. Your Primary Care Provider and sick to decide for yourself. Service Coordinator can help you get: › Access to needed specialists. How do I get an advance directive? › Materials prepared in a If you would like information or way you understand. have questions about creating an › Preadmission Screening and Resident advance directive, call a Cigna Service Review (PASRR) Specialized Services. Coordinator at 1-877-725-2688. › Specialized Medical equipment. › Assistive technology services for adults. What do I do with an advance directive? To learn more, please call your Service After you create your advance directive, you Coordinator at 1-877-725-2688. If you can take it or mail it to your doctor and let are deaf or hard of hearing, please call your Service Coordinator know. Your doctor TTY: 7-1-1. For additional deaf or hard will know what kind of care you want. of hearing services, please call TTY/ Texas Relay at 1-800-735-2989 (English) How do I change or cancel or 1-800-662-4954 (Spanish). an advance directive? You can change your mind at any time What if I am too sick to make a after you have signed an advance directive. decision about my medical care? Call your doctor and Service Coordinator Under federal law, you have the right to fill to remove the advance directive from out an advance directive. You should fill your medical record. You can also make out an advance directive to make sure you changes in the advance directive by get the kind of care you want. Call Member filling out and signing a new one. Services at 1-877-653-0327, Monday to Friday, 8 a.m. to 5 p.m. Central Time. A Service Coordinator can provide help.

Important Cigna can’t offer legal advice or serve as a witness. Talk to your family, your Primary Care Provider or your Service Coordinator to help with an advance directive.

31 32 Bills, change of address, and lost or limited coverage Member Services at 1-877-653-0327 Services Member additionalyou call assistance please need information the on bill you received. If yourverify protect identity and the and other personal information to You may asked be for your ID Cigna need? they will information What Central to Time 5p.m. 8 a.m. 1-877-653-0327 You at Services Member also call can Icall? do Who to bill for is your on the card. services ID All offile. the information your needs doctor have information your correct Medicaid on the to doctor’s office Call make sure they my doctor? from abill Iget if What YOU MAY HAVE. GET ANSWERS TO QUESTIONS your to card ID adoctor’s visit. To avoid billing mix-ups, always bring Hint

, Monday to Friday, . https://www.YourTexasBenefits.com To more visit learn of proofdocuments by date. the due return the renewal application and Look at the options, health and plan date Sign and correct. the application. Fixapplication. any information that is not towill over need look the renewal to order In renew your coverage, you household income and cost deductions. a letter for asking update an your on packet Itincludes contains application. an renewal The packet in the mail from HHSC. every year. You will receive arenewal You renew coverage must your Medicaid completing my renewal application? with help Ihave do Ineed if toWhat do Provider Care you Primary before. had same coverage.Medicaid You will also have the youhealth plan before had losing your from the same services your Medicaid within again back you 6months, will get youIf coverage lose Medicaid get but it Medicaid coverage? my Ilose if happens What your changes until address. HHSC will continue to through get care Cigna You services. emergency youunless need in your you Cigna, new call area, must 0327 at 1-877-653- Services Member Cigna call and give office benefits it to HHSC the local you as soon haveAs your new address, Ihave do Imove? if toWhat do . Before you get Medicaid services . Before services you get Medicaid

. Medicare-Medicaid beneficiaries (Duals) beneficiaries Medicare-Medicaid

LEARN MORE IF YOU HAVE MEDICARE AND MEDICAID.

What if I also have Medicare? What if I have other health insurance If you have Medicare and STAR+PLUS, in addition to Medicaid? Medicare will be your main coverage. Medicaid and Private insurance This means that your Medicare You are required to tell Medicaid staff coverage is always the first insurance about any private health insurance to use. STAR+PLUS will not change you have. You should call the Medicaid your Medicare coverage. Third Party Resources hotline and update your Medicaid case file if: Can my Medicare provider bill me Your private health insurance for services or supplies if I am in › is canceled. both Medicare and Medicaid? › You get new insurance coverage. You cannot be billed for Medicare “cost- You have general questions sharing,” which includes deductibles, › about third party insurance. coinsurance and co-payments that are covered by Medicaid. You can call the hotline toll-free at 1-800-846-7307. If you have other insurance, you may still qualify for Medicaid. When you tell Medicaid staff about your other health insurance, you help make sure Medicaid only pays for what your other health insurance does not cover.

Important Medicaid providers cannot turn you down for services because you have private health insurance as well as Medicaid. If providers accept you as a Medicaid patient, they must also file with your private health insurance company.

33 4. You have the right to agree to KNOW YOUR or refuse treatment and actively RIGHTS AND participate in treatment decisions. That includes the right to: RESPONSIBILITIES. a. Work as part of a team with your provider in deciding what health care is best for you. What are my rights and responsibilities? b. Say yes or no to the care Member rights: recommended by your provider. 1. You have the right to respect, 5. You have the right to use each dignity, privacy, confidentiality, complaint and appeal process Rights and responsibilities and nondiscrimination. available through the managed That includes the right to: care organization and through Medicaid, and get a timely response a. Be treated fairly and with respect. to complaints, appeals and State Fair b. Know that your medical records Hearings. That includes the right to: and discussions with your providers a. Make a complaint to your health will be kept private and confidential. plan or to the state Medicaid 2. You have the right to a reasonable program about your health care, opportunity to choose a health care your provider or your health plan. plan and Primary Care Provider. This b. Get a timely answer to is the doctor or health care provider your complaint. you will see most of the time and who will coordinate your care. You c. Use the plan’s appeal process have the right to change to another and be told how to use it. plan or provider in a reasonably easy d. Ask for a State Fair Hearing from manner. That includes the right to: the state Medicaid program a. Be told how to choose and and get information about change your health plan and how that process works. your Primary Care Provider. 6. You have the right to timely access b. Choose any health plan you to care that does not have any want that is available in your communication or physical access area and choose your Primary barriers. That includes the right to: Care Provider from that plan. a. Have telephone access to a medical c. Change your Primary Care Provider. professional 24 hours a day, 7 days a week to get any emergency d. Change your health plan or urgent care you need. without penalty. b. Get medical care in a e. Be told how to change your health timely manner. plan or your Primary Care Provider. c. Be able to get in and out of a health 3. You have the right to ask questions and care provider’s office. This includes get answers about anything you do not barrier free access for people with understand. That includes the right to: disabilities or other conditions that a. Have your provider explain limit mobility, in accordance with your health care needs to the Americans with Disabilities Act. you and talk to you about the d. Have interpreters, if needed, different ways your health care during appointments with your problems can be treated. providers and when talking to b. Be told why care or services your health plan. Interpreters were denied and not given. include people who can speak in your native language, help someone with a disability, or help you understand the information.

34 Rights and responsibilities and Rights e. Be given information you f. Always contact your Primary can understand about your Care Provider first for your non- health plan rules, including the emergency medical needs. health care services you can g. Be sure you have approval from get and how to get them. your Primary Care Provider 7. You have the right to not be restrained before going to a specialist. or secluded when it is for someone h. Understand when you else’s convenience, or is meant to should and should not go force you to do something you do to the emergency room. not want to do, or is to punish you. 3. You must share information about 8. You have a right to know that your health with your Primary doctors, hospitals, and others who Care Provider and learn about care for you can advise you about service and treatment options. That your health status, medical care, includes the responsibility to: and treatment. Your health plan a. Tell your Primary Care cannot prevent them from giving you Provider about your health. this information, even if the care or treatment is not a covered service. b. Talk to your providers about your health care needs and 9. You have a right to know that you ask questions about the are not responsible for paying for different ways your health care covered services. Doctors, hospitals, problems can be treated. and others cannot require you to pay copayments or any other c. Help your providers get amounts for covered services. your medical records. 4. You must be involved in decisions Member responsibilities: relating to service and treatment 1. You must learn and understand options, make personal choices, and each right you have under take action to keep yourself healthy. the Medicaid program. That That includes the responsibility to: includes the responsibility to: a. Work as a team with your a. Learn and understand your rights provider in deciding what under the Medicaid program. health care is best for you. b. Ask questions if you do not b. Understand how the things you understand your rights. do can affect your health. c. Learn what choices of health c. Do the best you can to stay healthy. plans are available in your area. d. Treat providers and 2. You must abide by the health staff with respect. plan’s and Medicaid’s policies e. Talk to your provider about and procedures. That includes all of your medications. the responsibility to: Additional Member Responsibilities a. Learn and follow your health while using NEMT Services: plan’s rules and Medicaid rules. 1. When requesting NEMT Services, b. Choose your health plan and a you must provide the information Primary Care Provider quickly. requested by the person arranging c. Make any changes in your health or verifying your transportation. plan and Primary Care Provider 2. You must follow all rules in the ways established by and regulations affecting Medicaid and by the health plan. your NEMT services. d. Keep your scheduled appointments. 3. You must return unused advanced e. Cancel appointments in advance funds. You must provide proof that you when you cannot keep them. kept your medical appointment prior to receiving future advanced funds. 35 4. You must not verbally, sexually, you made a complaint. No one can or physically abuse or harass stop you from making a complaint. anyone while requesting or receiving NEMT services. How to file a complaint: 5. You must not lose bus tickets or tokens › By calling: 1-866-566-8989. and must return any bus tickets or People who are deaf, hard of hearing tokens that you do not use. You must or speech impaired can call any HHSC use the bus tickets or tokens only to office by using the toll-free Texas Relay go to your medical appointment. service at: 7-1-1 or 1-800-735-2989. 6. You must only use NEMT › On the internet: services to travel to and from hhs.texas.gov/managed-care-help. Rights and responsibilities your medical appointments. Online Submission form. 7. If you have arranged for an NEMT › By mail: service but something changes, Texas Health and and you no longer need the service, Human Services Commission you must contact the person Office of the Ombudsman, MC H-700 who helped you arrange your PO Box 13247 transportation as soon as possible. Austin, TX 78711-3247 If you think you have been treated › By fax: 1-888-780-8099 (Toll-Free) unfairly or discriminated against, call the U.S. Department of Health and Your Responsibilities: Human Services (HHS) toll-free at › You must allow your attendant to 1-800-368-1019. You also can view use EVV to clock-in and clock-out information concerning the HHS Office of in one of the following ways: Civil Rights online at www.hhs.gov/ocr. – EVV mobile method – EVV alternative device What are my rights and – Your home landline telephone responsibilities specific to Your attendant can’t use your personal Electronic Visit Verification (EVV)? › cell phone to clock-in or clock-out. Texas requires attendants who deliver › You must tell your provider agency if certain Medicaid services to use your attendant asks you to clock-in or Electronic Visit Verification. The EVV clock-out of the EVV system for them. system makes sure your approved › If you use an EVV alternative device services are provided to you. that is placed in your home, it must remain in your home at all times. Your Rights: You must tell your provider › Your private information may only agency or your Health Plan Service be shared in specific situations Coordinator immediately if: that follow state and federal guidelines and regulations. › The EVV alternative device has been removed from your home or damaged. › You don’t have to let your attendant use your home telephone. › You think someone has tampered with the EVV alternative device. › You can ask for an interdisciplinary meeting or service plan team meeting › If a zip tie was used to install the device with your health plan’s service has been cut, damaged or broken. coordinator about concerns You must return the EVV alternative using EVV. device to your provider agency when › You have the right to make a complaint, you aren’t receiving Medicaid services voice grievances or recommend any more. You can ask the agency to changes in policy or service. No one remove the device from your home. can treat you differently because

36 Rights and responsibilities and Rights Frequently Asked Questions (FAQ): › Option 1 Your provider agency may order an Do I have to participate in EVV? EVV alternative device. The device Yes, if you get services that require EVV. may be placed or installed by using You must allow your attendant to clock-in the EVV vendor zip tie in your when they begin and clock-out when they home. It must be in an area where end services using one of the acceptable your attendant can reach it. Once methods. EVV is required for certain installed, the device must remain in your home at all times. A Medicaid home and community based services, fraud referral may be made to OIG such as Personal Attendant Services, if the device isn’t in your home at all Protective Supervision, Personal Care times while you are receiving Medicaid Services, In-home Respite, Flexible Family services. A fraud referral may end up Support and Community First Choice. affecting your ability to get services. If you choose Consumer Directed › Option 2 Services or the Service Responsibility Your attendant may use their smart Option, you will be required to comply phone with an EVV mobile method. with all the EVV requirements starting Also, remember if you choose Consumer with dates of service January 1, 2021. Directed Services option or the Service Responsibility Option, the EVV How do attendants requirements went into effect Jan. 1, 2021. clock-in and clock-out? Attendants must use one of the Can I receive services in the following to clock-in and clock-out: community with EVV? › The attendant’s smart phone Yes. EVV doesn’t change the location using an EVV mobile method for where you get services. You can › An EVV alternative device get services in accordance with your › Your home landline telephone service plan and the existing program (but only with your permission) rules, at home and in the community. You aren’t allowed to clock-in or clock- Who do I contact with out of the EVV system for the attendant questions or concerns? for any reason. If you clock-in or clock- out for your attendant, a Medicaid fraud Please contact your provider referral may be made to the Office of agency representative or health Inspector General, which may end up plan’s service coordinator if you affecting your ability to get services. have any questions or concerns. For more information on EVV, please What if I don’t have a home landline visit our website at: https://hhs.texas. telephone or I don’t want my gov/doing-business-hhs/provider- attendant to use my home landline? portals/long-term-care-providers/ If you don’t have a home landline resources/electronic-visit-verification. telephone, or don’t want your attendant to use your home landline phone, tell this to your attendant or nurse as soon as possible. The following are two options available other than your home landline that your attendant may use to clock-in and clock-out.

37 LET’S WORK TOGETHER TO FIX A PROBLEM.

What should I do if I have a complaint Who do I call? We want to help. If you have a complaint, If you or your legally authorized Complaints please call us toll-free at 1-877-653- representative need help filing your 0327 to tell us about your problem. complaint, a Cigna Member Services A Cigna Member Services Advocate representative or a Cigna Member can help you file a complaint. Just call Advocate can help you. You can call Member Services at 1-877-653-0327. Member Services at 1-877-653-0327. Most of the time, we can help you right Can someone from Cigna help away or at the most within a few days. me file a complaint? Once you have gone through the Cigna If you or your legally authorized complaint process, you can complain to the representative need help filing your Health and Human Services Commission complaint, a Cigna Member Services (HHSC) by calling toll-free 1-866-566-8989. representative or a Cigna Member Advocate can help you. You can call If you would like to make your Member Services at 1-877-653-0327. complaint in writing, please send it to the following address: How long will it take to Texas Health and Human process my complaint? Services Commission We will send you a letter within 5 Business Ombudsman Managed Care Days of receiving your complaint. This letter Assistance Team will let you know that we received your PO Box 13247 complaint. We will send you another letter Austin, TX 78711-3247 within 30 Days of receiving your complaint. If you can get on the Internet, you This letter will let you know what actions can submit your complaint at: we took to address your complaint. hhs.texas.gov/managed-care-help What are the requirements and timeframes for filing a complaint? You can file a complaint over the phone or in writing at any time.

STAND UP FOR YOUR RIGHTS.

What can I do if my doctor asks for Appeals a service or medicine for me that is covered but Cigna denies or limits it? You or your legally authorized representative can file an appeal with Important Cigna. Your provider can be your legally authorized representative. If Cigna does not receive your appeal filing form within 60 Days How will I find out if services are denied? of the date of the decision letter, You will receive a letter if a your appeal will not be reviewed. covered service is: Help is always there. › Not approved. If you have any questions, just call › Delayed. Member Services at 1-877-653-0327. › Reduced or limited. › Stopped. 38 Appeals 39 . Days after the date of decision letter. decision of after date the Days Legal Authorized Representative asked have unless you (LAR), an Appeal. Expedited for Received by Cigna no later than 60 than Cignano later by Received or your you andCompleted signed by

› › When can I ask a State Fair appeal?Hearing my review to Authorized Legal or your You (LAR) can a ask for Representative Hearing after only exhausting Fair State For process. Appeal Internal Cigna the the can to turn you information more Hearing Section on page41. Fair State Can someone from Cigna Cigna from someone Can help me file an appeal? can Cigna A Member Advocate Yes. file an appealhelp Call you necessary. if Member Services 1-877-653-0327 at Can I file appeal my orally? must be oral appeal received Every signed appeal a written, confirmed by member the Authorized Legal orby the an unless (LAR) Representative AppealExpedited requested. is your favor, you may be required to to be required may you favor, your services furnished of cost the pay appeal pending. your is while health plan’s decision letter, or letter, decision plan’s health be reduced or services end. will your If your appeal is not resolved in appeal resolved not If your is 10 Days from the date of the of date the from 10 Days says letter plan’s health the The day

that your services going keep your that of: later the on or before not approved in whole in or part.in approved not Cigna will send you or your legally or your send you Cigna will written representative authorized delay the for reason the of notice delay. the ask for not did you if up to 14 Days if you or your legallyor your you if Days 14 up to authorized representative asks for how Cigna shows oran if extension, or information more need for the best interest. your in is a delay authorized representative a written written a representative authorized date the from 30 Days within decision appeal your request. received we your request, Cigna will send you or send request, you Cigna will your your legally authorized representative your that confirmation written request has been received. representative must file your appeal must file your representative date the from 60 Days request within service. the approve not Cigna did File your appeal your requestFile and ask Delayed, limited, or stopped. or limited, Delayed, serviceis a covered for If a payment Not approved. If the timeframe is extended, is timeframe If the Your appeal request can be extended extended can be request appeal Your Cigna will send you or your legally or your send you Cigna will Within 5 Business Days of receiving receiving of 5 Business Days Within You or your legally authorized authorized legally or your You – – –

› › › › › › › › › How canHow getting I keep services while appeal my is in process? how you tell will receive you The letter can benefits getting keep you while keep appeal process. in your To is services, these must:getting you When the do right I have askto for an appeal? authorized legally or your You ask for to has right the representative service is: an appeal a covered if What is the timeframe foran appeal? anThe appeal for timeframe is: 40 Expedited Appeals KNOW HOW TO ASK FORARUSHAPPEAL. of the outcome of the Expedited appeal representative authorized legally your or hospitalization, for telling the timeframe you of continued denial or emergency ongoing your relates Unless request tohours. an representative of decision within our 72 We will tell you your or legally authorized Appeal? Expedited an for timeframes the are What excludingTime State-approved holidays. Monday to Friday, Central to 5p.m. 8 a.m. 1-877-653-0327 at representative Services byExpedited Appeal aMember calling Representative for ask an can (LAR) youNo, your or Legally Authorized have writing? in to my be request Does at Services For Member help, call Fax: TN 37202 Nashville, Box 24207PO STAR+PLUSCigna Appeals representative to: arequest fax mail or can you your or services, legally authorized For prescription drug/pharmacy Expeditedpharmacy Appeal? drug/ aprescription for Iask How do at Services For Member help, call Fax: 76095 TX Bedford, Box 211088 PO Complaints Department and Appeals Cigna to: arequest fax mail or can representative authorized legally you your or services, For medical Appeal? Expedited an for Iask How do could jeopardize your life health. or and taking the time for a standard appeal the on conditionbased of your health to has plan make adecision quickly the is health when Expedited Appeal An Appeal? Expedited an is What 1-877-653-0327 1-877-653-0327 1-866-593-4482 1-877-809-0783

. .

, for an Expedited Appeal, Cigna will: Cigna for Expedited Appeal, an the request denies and jeopardy in serious determines Cigna If your health life or is not Appeal? Expedited an for request the denies Cigna if happens What Day receiving after your request. will tell you later no than 1Business of continued hospitalization, we then denial or emergency for ongoing an is yourIf request Expedited Appeal Expeditedemergency Appeal? an for timeframe the is What representative did not for ask the delay. for delay if you your or legally authorized representative awritten notice of the reason give you your or legally authorized must Cigna the timeframe is extended, how the delay is in your interest. best If for morethere information is aneed and for extensionasks an shows Cigna or that representative authorized legally your extended if be youtimeframe can or extended to up be can 14 Days. This excluding State-approved holidays. to Friday, Central to Time, 5p.m. 8a.m. at 1-877-653-0327 Services Member Call Expedited Appeal. an file representative authorized legally your Advocate Member youor help or can A Cigna Member Services representative Appeal? Expedited an file me help can Who › ›

Follow with up you your or legally you yourCall or legally authorized written notice within 2Days. with a representative authorized followed. be will timeframe standard appeal process and representative to tell you a , Monday Monday , State Fair Hearing 41

1-877-809-0783 1-866-593-4482 1-877-653-0327. 1-877-653-0327 1-877-653-0327. Where dosend I request my for a Hearing? Fair State Hearing, or you Fair a State askfor To your legally authorized representative can to: or mail fax a letter Complaints and Appeals Cigna Hearing Fair Department State – PO 211088 Box Bedford, TX 76095 Fax: callhelp, MemberFor Services at Where do I send request my for a State Hearing Fair related to drugs/pharmacy? prescription Hearing for Fair a State ask for To or you drugs/pharmacy, prescription your legallyauthorized representative can to: or mail fax a letter Appeals Cigna STAR+PLUS PO 24207 Box Nashville, 37202 TN Fax: call help, MemberFor Services at Can getting I keep services that are not approved if I filed for a State Hearing? Fair any getting keep to right the have You planservice health denied the or reduced, final the your hearing if least decision at until appeal during the continued services were Fair a State for asked and you process date the from Hearing 10 on or Days before appeal letter. decision plan’s health the of Hearing resolved not is Fair State If the to be required may you favor, your in services furnished of cost the while pay Hearing pending. is Fair State your Hearing, will you Fair a State ask for If you time date, the you telling information get Fair hearing. the and of location Most State time, that phone.Hearings done are At by you why can say representative or your you need plan service not health did the the 90 A final made is decision within approve. hearing. the ask for you date the from Days Who can I talk about to a Hearing? Fair State can call Member ServicesYou at

1-877-653-0327 For help, call help, MemberFor Services at any getting keep to right the have You planservice health denied the or reduced, final the hearing least decisionat until continued services were madeis your if a appeal ask for your and you through if the following 10 Hearing Days by Fair State appeal the of letter. decision mailing MCO’s Hearing, will you Fair a State ask for If you you letting information of a packet get the and of time location date, the know Hearing held are Fair hearing. Most State or your you time, that telephone. At by need you the why can tell representative planservice health denied. the HHSC will 90 a final Days within decision you give hearing. the for asked you date the from Can I ask for a State Hearing? Fair asmember a If you, plan, health the of decision plan’s health the disagree with right the appeal, have your you deny to must Hearing. You Fair a State ask for to plans health appeal the process follow Hearing. Fair a State requesting before Hearing Fair request also a State may You a decision make plan to health fails the if time required the appealon your within frame. as a member If you, health the of decision plan’s health the plan, disagree with appeal, may you expedited your deny to Hearing. Fair State request an expedited you name represent someone may to You plan health telling the to a letter writing by to want name personthem the the of you medical A doctor or you. other represent If representative. be your may provider challenge an appeal to decision want you plan, or health your your you made by Fair must State the ask for representative of date the of Days 120 Hearing within the appeal with letter plan’s health the State the do ask for decision. not If you may you Days, 120 Hearing within Fair Hearing. Fair a State to right your lose Hearing, you Fair a State ask for To should either representative or your plan health at: the to send a letter Complaints and Appeals Cigna Hearing Fair Department State - PO 211088 Box Bedford, TX 76095 KNOW HOW TO ASK FOR A STATE FAIR HEARING. FAIR STATE A FOR ASK TO HOW KNOW 42 Waste, abuse and fraud Reporting abuse, neglect and exploitation for life-threatening situations. emergency or that is committed by aprovider. 9-1-1 Call unapproved use of restraints isolation or including Exploitation, or Neglect Abuse, lawThe requires that suspected you report Exploitation and Neglect Abuse, Reporting and taking property and other resources. account, joint a checking abusing checks, Income) Security (Supplemental SSI or Security Social taking This includes gain. another person for personal or monetary Exploitation hygiene. personal and care water,running electricity, medical of lack also heat, includes Neglect and unsanitary living conditions, etc. overmedicating or under-medicating, Neglect injury. such sexualor injury, failure or to prevent Abuse Exploitation? and Neglect Abuse, are What Exploitation. and Neglect Abuse, dignity, from freedom including You have the right to and respect EXPLOITATION. NEGLECT AND REPORT ABUSE, something wrong could waste, be abuse Doing something wrong. is doing benefits getting providers,care aperson or at store, adrug pharmacist other health Let know us if you think adoctor, dentist, Fraud? or Abuse Waste, you to report Do want RIGHT THING. TO DOTHE KNOW WHEN is mental, emotional, physical emotional, is mental, results in starvation, dehydration, dehydration, starvation, in results is misusing the resources of

exploited lives receives in or from a: services or neglected abused, being the person by(HHS) 1-800-458-9858 calling Services to Human Health and Report aday, toll-free hours 7days aweek, 24 (nonemergency); by phone Report numbers of everyone involved. everyone of numbers addresses ages, names, and phone exploitation, it to is helpful have the When reporting abuse, neglect or areport filing for information Helpful profile. and account password-protected a secure website. You to will need create a toGo https://txabusehotline.org Report electronically (nonemergency) 1-800-252-5400 by calling exploitation or neglect, to DFPS all abuse, other suspected Report (DFPS). Services of FamilyDepartment Protective and to reported also be must the by aHCSSA Exploitation or Neglect Abuse, Suspected example, tell if us you is: think someone which the law. is against fraud, or For › › › › › › › › › ›

Home and Home Community Support Licensed foster adult provider. care Adult day center. care facility. living Assisted Facility.Nursing Not tellingNot the truth the about else’s ID. Using someone Medicaid else use Letting someone telling Not the truth amedical about that for paid services Getting Home Health Agency.Home or (HCSSA) Agency Services he or she has to has she or he get benefits. of moneyamount resources or ID. their Medicaid condition to treatment. get medical weren’t given necessary. or . . This is is This . if if

Waste, abuse and fraud Terms and definitions 43 –

An Emergency Emergency – Evaluation of an of Evaluation –

Health care –

A complaint to your to A complaint and facility (if you have it). it). have you and (if facility therapist, pharmacist, etc.). can who witnesses other of help investigation. the in Social Security number or case it. have number you if abuse or fraud.waste, Medicaid number provider the of dentist, (doctor, provider of Type numbersphone and Names events. of Dates happened. what Summary of name.The person’s birth, of date The person’s personThe the city where lives. the about details Specific

› › › › › › › › › When reporting aboutWhen someone include: benefits, gets who Emergency Medical Condition – Condition Medical Emergency so or condition symptom, illness, injury, a reasonable personserious that would harm. avoid to seek away care right Emergency Transportation Medical an in get emergencyservices you room. Emergency Services emergency and medical treatment condition worse. getting from condition the keep to Services Excluded insurance health your that services oror cover. plan for doesn’t pay Grievance – or plan. insurer health Ground or ambulance air services for an emergency medical condition. Emergency Room Care ;

1-877-653-0327

https://oig.hhsc.state.tx.us/ Cigna 2208 Hwy 121, Ste. 210 Bedford, TX 76021 Phone: facility (hospital, nursing home, etc.). home agency, health number of provider. provider. of number to your health plan: health your to Click the box labeled box “Report the Click Fraud” “theand labeled then click box Reporting to "IG's Form” Fraud or online the form; complete Name and address of the of address Name and Name, address and phone and Name, address You can report directly You Call 1-800-436-6184 at OIG the hotline Visit

› › › › › When reporting about a provider (a (a reporting provider aboutWhen a dentist,doctor, etc.) counselor, include: To report abuse or fraud, waste, gather To as possible.as much information To report waste, abuseTo or fraud, choose oneof the following: Equipment ordered by a health care a health by ordered Equipment use. or extended everyday for provider DME include for but may Coverage equipment, oxygen to: limited not is wheelchairs, crutches, supplies. or diabetic Durable Medical Equipment (DME) – Equipment Medical (DME) Durable A fixed amount (for example, amountCopayment (for – A fixed care health a covered for $15) pay you the receive service, when you usually service. The amount can the vary by care service. health type covered of Complaint you that – A grievance or plan. insurer health your to communicate DEFINITIONS. Appeal – A request your for review to managed care organization again.a denial or a grievance TERMS AND 44 Terms and definitions plan toplan provide covered to services you. acontracthas with your health insurer or Participating Provider – to pay provider. a non-participating providers, your contract health insurer can there when such as are other no cases, of aparticipating provider. limited In a non-participating provider instead to insurer plan or from obtain services to obtain authorization from your health toservices you. Itmay more difficult be health to insurer plan or provide covered havewho doesn’t acontract with your ProviderNon-participating – services. care health provide contracted has plan or with to suppliersand your health insurer providers, facilities, –The Network medicine. of standards accepted disease its symptoms or that and meet treator injury, illness, an condition, to prevent, supplies needed or diagnose, Medically Necessary – overnightrequire an stay. in ahospital that usually doesn’t Care Outpatient Hospital usually requires overnight an stay. requires inpatient an as admission and Hospitalization of aterminalstages their families. illness and in the last for persons support and comfort Services Hospice receives aperson services in ahome. Home Health Care in exchange for apremium. your covered health costs care requires your health insurer to pay that contract –A Insurance Health for daily living. functioning and improve or keep,person learn, skills or occupational therapy that help a physical such as services Health care Devices and Services Habilitation

– Care in ahospital that Care

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Services to provide to provide Services – Health care care Health Health care services services care Health AProvider who

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– accredited required as by state law. health-care facility licensed, certified, or Medicine), professional, or health-care D.O. or Doctor of -Doctor Osteopathic – Provider services. access of arange health-care provides, coordinates, apatient helps or allowedassistant, as state under law, who physician or specialist, nurse clinical Osteopathic Medicine), practitioner, nurse D.O. or Doctor of -Doctor -Medical (M.D. physician –A Provider Care Primary for apatient. services health-care provides coordinates or of arange of Osteopathic Medicine) who directly D.O. or Doctor -Doctor -Medical (M.D. Physician Care Primary that by law require prescription. a medications and –Drugs Drugs Prescription medications. and prescription drugs thatinsurance plan pay or helps for Coverage Drug Prescription forpaid your health insurance plan. or Premium – willinsurance plan or cover the cost. authorization apromise isn’t your health receiving Pre- the requested service. prior to obtained be must certification, authorization, prior approval, or pre- or approval, sometimes called prior necessary.is This medically decision that you your or provider requested, has equipment medical durable or drug, prescription treatment plan, service, health that insurer plan or ahealth-care – Pre-authorization your services. health-care which provides pays and for like –Abenefit, Medicaid, Plan Medicine) provides coordinates. or D.O. or Doctor of -Doctor Osteopathic physician -Medical licensed medical (M.D. Physician – Services A physician (M.D. - Medical Aphysician -Medical (M.D. The amount that must be that be amount must The Adecision by your Health-care services a a services Health-care

– A physician physician A – Health Health Terms and definitions Annual information 45 A physician specialist A physician conditions, emergency services, services, emergency conditions, services. post-stabilization and PCP your from authorization prior services. care emergency for to including instructions on how telephone system 9-1-1 the use or local its equivalent. hospitals and providers where services emergency furnish Medicaid. by covered or other hospital any use to right emergency for settings care. What makes up emergency makes What medical do neednot The fact you that emergency get to services,How places any The addresses of a have you saying A statement rules.Post-stabilization

emergency coverage and limits to to limits and coverage emergency kinds benefits,those of including: care benefits and other for you PCP. your through get cannot Cigna’s practice guidelines. practice Cigna’s How you get after-hours and after-hours get you How specialty for on referrals Policy – – – – – –

› › › Specialist – Specialist medicine on of specific a area focuses diagnose, to patients of or a group certain types or treat manage, prevent and conditions. symptoms of Urgent Care– Care an illness, for injury serious enough or condition a reasonable person seekthat would as severe so but not away, care right emergency require care. room to Services planning services, from out-of-network planning services, from out-of-network benefits. those and to limits providers authorization requirements.authorization under Medicaid the program, and duration, amount, including benefits. of scope designed is This understand you sure the make to entitled. are you which benefits to and State Fair Hearing procedures. Fair and State choice among network providers. network among choice at a minimum primaryat care providers, specialists, our and in service hospitals include will area. information This numbers, telephone names, addresses, than (other spoken languages and each for provider, network English) that providers of plus identification patients. new accepting not are How you get benefits, get you How including family How you get benefits get including you How Information about benefits available available benefits about Information Your rights and responsibilities. Your appeal, complaint, on Information Any limits on your freedom on your limits of Any Information about network providers – providers network about Information

› › › › › › › Skilled Nursing – Care Skilled Rehabilitation Services and – Devices Health-care services as such physical a help that therapy occupational or skills back get person or improve keep, thatand functioning living daily for beenor lost impaired becausehave a person sick, hurt was or disabled. own nurses licensed from your in homeor a nursing in home. As a Member of Cigna can you ask for and get the information following each year: GET HELPFUL INFORMATION GET HELPFUL INFORMATION ALL YEAR LONG. 46 Notice of nondiscrimination Cigna: sex. or disability national age, origin, of race, differently color,them because not exclude does Cigna treat or people sex. or disability national age, origin, discriminate the on basis of race, color, civilFederal rights laws not does and Cigna complies with applicable IS AGAINST THELAW. KNOW THAT DISCRIMINATION › ›

– – – – Provides to services language free Provides to services and aids free not English, such as: such not English, people whose primary language is effectively with such as: us, withpeople disabilities to communicate

Information written in Qualified interpreters. Written information in other formats signQualified interpreters. language other languages. electronic formats, other formats). (large print, accessible audio,

www.hhs.gov/ocr/office/file/index.html Complaint forms are available at (TDD 800-537-7697 1-800-368-1019, 20201 DC Washington, 509F, Building Room HHH 200 Independence Avenue, SW and Human Services Health of Department U.S. lobby.jsf https://ocrportal.hhs.gov/ocr/portal/ availableRights Complaint Portal, at for Civil throughelectronically the Office for Civil Rights, Office Services, Human of Health and Department with the U.S. You also acivil file can rights complaint is available Services to you. Member help filing agrievance, help you If fax. or need You agrievance file can in writing by mail Fax: Central to Time. 7 days 5p.m. 8a.m. aweek, 7-1-1) (TTY: 1-877-653-0327 76095 TX Bedford, Box 211088 PO Attn: Appeals Complaints and Department Cigna sex,or you agrievance file can with: of race, color, disability national age, origin, discriminated way in another the on basis to failed has provide or these services you If believe Services. thatMember Cigna contact these youIf services, need 1-877-809-0783

, or by, or at: phone mail or

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Multi-language Interpreter Services 47

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با شماره با شماره ານ ານ ່ ່ ທ ທ 㚕રો 㚕રો (TTY 711) (TTY 711) (TTY ່ ່ . ફોન . ફોન ે ે 1-877-653-0327 1-877-653-0327 。 711) (TTY 。 711) (TTY ການແກ ການແກ ລ ລ ິ ິ ບ ບ ໍ ໍ ້ ້ ℂ । 1-877-653-0327 1-877-653-0327 1-877-653-0327 ઉપલબ㚧 છ ઉપલબ㚧 છ ે ે ອມໃຫ ອມໃຫ TTY 711) 711) TTY 711) TTY ້ ້ າ ພ າ ພ ່ ່ TTY 711) 1-877-653-0327 711) TTY 1-877-653-0327 711) TTY उपलब㔧 ि क ु ल ເສຍຄ ເສຍຄ ःश ໍ ໍ ່ ່ न 0327-653-877-1۔ يہ کال مفت ہے. 0327-653-877-1۔ يہ کال مفت ہے. વ뺾ઓ તમ뺾ર뺾 મ뺾ટ વ뺾ઓ તમ뺾ર뺾 મ뺾ટ ે ે एं न 봾 ). هذه المكالمة بالمجان. ). هذه المكالمة بالمجان. सेव 봾 . . Díí béésh bee hane’ígíí t’áá jíík’eh. Díí béésh bee hane’ígíí t’áá jíík’eh. າ າ ່ ່ ານພາສາ ໂດຍບ ານພາສາ ໂດຍບ ້ ້ ອດ ອດ सि봾्त 봾 ເສຍຄ ເສຍຄ ຼ ຼ ື ື ष (TTY 711). La chiamata è gratuita. 711). (TTY (TTY 711). La chiamata è gratuita. 711). (TTY ໍ ໍ ່ ່ (TTY 711). Libre ang tawag na ito. 711). (TTY Libre ang tawag na ito. 711). (TTY ુ ુ લ㚕 ભ뺾ષ뺾 સહ뺾્ સ લ㚕 ભ뺾ષ뺾 સહ뺾્ સ ນບ ນບ ່ ່ ວຍເຫ ວຍເຫ ए भ봾 (TTY 711). (TTY 711). (TTY ) تماس بگيريد. اين تماس رايگان است. ) تماس بگيريد. اين تماس رايگان است. ່ ່ ແມ ແມ ल ້ ້ ີ ີ े ल ການຊ ການຊ ລ ລ ິ ິ (TTY 711). Dieser Anruf ist kostenlos. Dieser 711). (TTY (TTY 711). Dieser Anruf ist kostenlos. Dieser 711). (TTY . ે ે ບ ບ ໍ ໍ خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم ملحوظة: إذا كنت تتحدث اللغة العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم ملحوظة: إذا كنت تتحدث اللغة العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم । ै (ATS 711). Cet appel est gratuit. 711). (ATS Cet appel est gratuit. 711). (ATS ີ ີ ि ບການໂທນ ບການໂທນ

ℂ तो आपक 1-877-653-0327 1-877-653-0327 ັ ັ क ि زبانی به صورت رايگان برای شما فراهم می باشد. توجه: اگر به زبان فارسی صحبت می کنيد، تسهيالت زبانی به صورت رايگان برای شما فراهم می باشد. توجه: اگر به زبان فارسی صحبت می کنيد، تسهيالت زبانی به صورت رايگان برای شما فراهم می باشد. (TTY 711). Звонок бесплатный. Звонок 711). (TTY бесплатный. Звонок 711). (TTY າລ າລ ु ल ໍ ໍ 1-877-653-0327 1-877-653-0327 توجہ ديں: اگرآپ اردو زبان بولتے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں۔ کال کريں توجہ ديں: اگرآپ اردو زبان بولتے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں۔ کال کريں ःश ુ ુ જર뺾તી બોલત뺾 હો તો નન:શ જર뺾તી બોલત뺾 હો તો નન:શ ( για χρήστες TTY, καλέστε 711). Η κλήση αυτή είναι δωρεάν. 711). καλέστε TTY, ( για χρήστες Η κλήση αυτή είναι δωρεάν. 711). καλέστε TTY, ( για χρήστες ગ ગ ે ે 1-877-653-0327 1-877-653-0327 າພາສາລາວ, ຈະມ າພາສາລາວ, ຈະມ (TTY 711). Esta llamada es gratuita. Esta llamada es 711). (TTY es gratuita. Esta llamada 711). (TTY ້ ້ 1-877-653-0327 1-877-653-0327 ົ ົ (TTY 711). To połączenie jest bezpłatne. To 711). (TTY połączenie jest bezpłatne. To 711). (TTY (TTY 711). ສ 711). (TTY ສ 711). (TTY ्ि कॉल नन

। ᴂ ານເວ ານເວ (TTY 711). This call is free. This call 711). (TTY is free. This call 711). (TTY ່ ່ າທ າທ ້ ້ (TTY 711). Cuộc gọi này miễn phí. Cuộc 711). (TTY gọi này miễn phí. Cuộc 711). (TTY Apèl sa a gratis. 711). (TTY Apèl sa a gratis. 711). (TTY (TTY 711). Esta ligação é gratuita. 711). (TTY (TTY 711). આ 㚕ૉલ મફત છ 711). (TTY આ 㚕ૉલ મફત છ 711). (TTY (TTY 711). Esta ligação é gratuita. 711). (TTY : अगर आप हिंदी बोलते : ຖ : ຖ ᴂ ່ ່ – ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. de asistencia lingüística. servicios gratuitos a su disposición habla español, tiene si ATENCIÓN: – de asistencia lingüística. servicios gratuitos a su disposición habla español, tiene si ATENCIÓN: – 1-877-653-0327 1-877-653-0327 – PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa maaari kang gumamit Tagalog, Kung nagsasalita ka ng – PAUNAWA: ng mga serbisyo ng tulong sa maaari kang gumamit Tagalog, Kung nagsasalita ka ng – PAUNAWA: າໃຈໃສ າໃຈໃສ – ATTENTION: If you speak English, language assistance services, free of charge are available to you. of charge are available services, free language assistance If you speak English, ATTENTION: – to you. of charge are available services, free language assistance If you speak English, ATTENTION: – ध्봾न द

1-877-653-0327 1-877-653-0327 ົ ົ – UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod z bezpłatnej pomocy językowej. Jeżeli mówisz po polsku, możesz skorzystać – UWAGA: pomocy językowej. Zadzwoń pod Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej – UWAGA: – ATTENZIONE: nel caso in cui la lingua parlata sia l’italiano, sono disponibili servizi di assistenza nel caso ATTENZIONE: – – ATTENZIONE: nel caso in cui la lingua parlata sia l’italiano, sono disponibili servizi di assistenza nel caso ATTENZIONE: –

— ີ ີ ່ ່ Arabic – Arabic – – ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para Se fala português, ATENÇÃO: Portuguese – – ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen ACHTUNG: Wenn German – Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen ACHTUNG: Wenn German – Rufnummer: zur Verfügung. – ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги услуги доступны вам бесплатные языке, то на русском вы говорите Russian – ВНИМАНИЕ: Если 1-877-653-0327 Звоните перевода. услуги доступны вам бесплатные языке, то на русском вы говорите Russian – ВНИМАНИЕ: Если Tagalog 1-877-653-0327 Звоните перевода. sa 1-877-653-0327 Tumawag wika nang walang bayad. Tagalog sa 1-877-653-0327 Tumawag wika nang walang bayad. ໂທໄປທ ໂທໄປທ Urdu – Urdu – まで、お電話にてご連絡ください。この通話は無料です。 711) (TTY t’11 1k1’1n7da’1wo’d66’, bee saad Bizaad, saad bee y1n7[ti’go Diné D77 n7n7zin: baa ak0 Navajo – D77 h0d77lnih n1 h0l=, koj8’ 47 jiik’eh, Japanese – 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 numer 1-877-653-0327 numer 1-877-653-0327 此電話免費。 phí dành cho bạn. Gọi số có các dịch vụ hỗ trợ ngôn ngữ miễn Việt, Tiếng nói – CHÚ Ý: Nếu bạn Vietnamese 此電話免費。 1-877-653-0327 phí dành cho bạn. Gọi số có các dịch vụ hỗ trợ ngôn ngữ miễn Việt, Tiếng nói – CHÚ Ý: Nếu bạn Vietnamese pou ou. Rele sèvis èd pou lang ki disponib gratis gen Ayisyen, Si w pale Kreyòl ATANSYON: French Creole – 1-877-653-0327 1-877-653-0327 pou ou. Rele sèvis èd pou lang ki disponib gratis gen Ayisyen, Si w pale Kreyòl ATANSYON: French Creole – 무료로 이용하실 수 있습니다. 1-877-653-0327 사용하시는 경우, 언어 지원 서비스를 Korean – 주의: 한국어를 1-877-653-0327 . 전화해 주십시오. 이 전화는 무료입니다 번으로 711) (TTY 무료로 이용하실 수 있습니다. 1-877-653-0327 사용하시는 경우, 언어 지원 서비스를 Korean – 주의: 한국어를 Polish . 전화해 주십시오. 이 전화는 무료입니다 번으로 711) (TTY Polish parlez français, des services d’aide linguistique vous sont proposés : Si vous ATTENTION French – Appelez le gratuitement. parlez français, des services d’aide linguistique vous sont proposés : Si vous ATTENTION French – Appelez le gratuitement. – ΠΡΟΣΟΧΗ: Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά. ελληνικά. για εσάς εάν μιλάτε διαθέσιμες δωρεάν υπηρεσίες υποστήριξης Υπάρχουν Greek – ΠΡΟΣΟΧΗ: 1-877-653-0327 στο Καλέστε ελληνικά. για εσάς εάν μιλάτε διαθέσιμες δωρεάν υπηρεσίες υποστήριξης Υπάρχουν Greek – ΠΡΟΣΟΧΗ: Lao – ເອ 1-877-653-0327 στο Καλέστε Lao – ເອ まで、お電話にてご連絡ください。この通話は無料です。 711) (TTY t’11 1k1’1n7da’1wo’d66’, bee saad Bizaad, saad bee y1n7[ti’go Diné D77 n7n7zin: baa ak0 Navajo – D77 h0d77lnih n1 h0l=, koj8’ 47 jiik’eh, Japanese – 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 – ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para Se fala português, ATENÇÃO: Portuguese – 1-877-653-0327 Italian linguistica gratuiti. Chiamare il numero 1-877-653-0327 – 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 Chinese 1-877-653-0327 Chinese – 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-653-0327 1-877-653-0327 Italian linguistica gratuiti. Chiamare il numero 1-877-653-0327 H8423_19_71428 APPROVED 01302019 H8423_19_71428 APPROVED 01302019 H8423_19_71428 APPROVED Farsi/Persian – Rufnummer: zur Verfügung. Farsi/Persian – Llame al Llame al Multi-language Interpreter Services Interpreter Multi-language English Services Interpreter Multi-language Call 1-877-653-0327 English Spanish Call 1-877-653-0327 Spanish Gujarati – ધ્뺾ન આપો: જો તમ Gujarati – ધ્뺾ન આપો: જો તમ पर कॉल कर 711) (TTY Hindi Multi-languageServices Interpreter 48 Notes

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-877-653-0327 (TTY: 7-1-1), Monday to Friday, 8 a.m. to 5 p.m. Central Time. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. © Cigna 2021 953774