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Handbook Ng Miyembro/ Ebidensiya Ng Pagsaklaw Anthem Blue Cross Cal Mediconnect Plan (Medicare-Medicaid Plan)

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Handbook Ng Miyembro/ Ebidensiya Ng Pagsaklaw Anthem Blue Cross Cal Mediconnect Plan (Medicare-Medicaid Plan) Santa Clara County, CA 2020 Handbook ng Miyembro/ Ebidensiya ng Pagsaklaw Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Mayroong mga tanong? Tawagan kami sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes, 8 a.m. hanggang 8 p.m. Libre ang tawag na ito. O bumisita sa duals.anthem.com. H6229_20_110117_U_TA CMS Accepted 09/03/2019 5041103 501601CADTAABC 2020 CA MMP EOC_SC2020 CA MMP EOC_SC_DAO_CQ.indd 2 2019/9/18 14:05:04 H6229_20_110117_U_TA CMS Accepted 09/03/2019 500750CADTAABC Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Handbook ng Miyembro Enero 1, 2020 – Disyembre 31, 2020 Ang Saklaw ng Iyong Kalusugan at Gamot sa ilalim ng Anthem Blue Cross Cal MediConnect Plan Handbook ng Miyembro Panimula Sinasabi ng handbook na ito sa iyo ang tungkol sa iyong saklaw sa ilalim ng Anthem Blue Cross Cal MediConnect Plan hanggang Disyembre 31, 2020. Ipinapaliwanag nito ang mga serbisyo sa pangangalaga ng kalusugan, serbisyo sa kalusugan ng pag-uugali (kalusugang pangkaisipan at karamdaman dahil sa labis na paggamit ng droga o alak), saklaw sa inireresetang gamot, at mga pangmatagalang serbisyo at suporta. Tumutulong ang mga pangmatagalang serbisyo at suporta sa iyo upang manatili sa tahanan sa halip na pumunta sa isang nursing home o ospital. Binubuo ang mga pangmatagalang serbisyo at suporta ng Community-Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP), at mga Nursing Facility (NF). Makikita ang mga mahahalagang termino at ang kanilang mga kahulugan sa pagkakasunud-sunod ayon sa alpabeto sa huling kabanata ng Handbook ng Miyembro. Isa itong importanteng legal na dokumento. Mangyaring itabi ito sa isang ligtas na lugar. Itong Cal MediConnect Plan ay ipinagkakaloob ng Anthem Blue Cross. Kapag sinabi nitong Handbook ng Miyembro ang “kami,” “namin,” o “amin,” nangangahulugan itong Anthem Blue Cross. Kapag sinasabi nitong “ang plan” o “aming plan,” nangangahulugan ito na Anthem Blue Cross Cal MediConnect Plan. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-855-817-5785 (TTY: 711), Monday through Friday from 8 a.m. to 8 p.m. The call is free. ATENCIÓN: Si usted habla español, tiene a su disposición servicios gratuitos de Spanish asistencia de idiomas. Llame al 1-855-817-5785 (TTY: 711), de lunes a viernes, de 8:00 a. m. a 8:00 p. m. La llamada es gratuita. 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 1-855-817-5785 (TTY: 711)，週一至週五上午 8：00-晚上 8：00。通話免費。 CHÚ Ý: Nếu quý vị nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ, miễn phí, cho Vietnamese quý vị. Xin gọi số 1-855-817-5785 (TTY: 711), Thứ Hai đến Thứ Sáu từ 8:00 sáng đến 8:00 tối. Cuộc gọi được miễn tính cước phí. Kung may mga tanong ka, pakitawagan ang Anthem Blue Cross Cal MediConnect Plan sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes mula 8 a.m. hanggang 8 p.m. ? Libre ang tawag. Para sa karagdagang impormasyon, bisitahin ang duals.anthem.com. 1 Anthem Blue Cross Cal MediConnect Plan HANDBOOK NG MIYEMBRO PAALALA: Kung nagsasalita ka ng Tagalog, magagamit mo nang walang bayad Tagalog ang mga serbisyo ng tulong sa wika. Tumawag sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes, 8:00 a.m. hanggang 8:00 p.m. Libre ang tawag. Maaari mong makuha ang dokumentong ito nang libre sa ibang format, tulad ng malalaking letra, braille, at/o audio. Tumawag sa 1-855-817-5785 (TTY: 711) Lunes hanggang Biyernes mula 8 a.m. hanggang 8 p.m. Libre ang tawag. Makukuha mo ang dokumentong ito nang libre sa iba pang mga wika at format tulad ng malalaking letra, braille, o audio. Tumawag sa Member Services sa numerong nakalista sa ilalim ng pahinang ito. Kapag tumatawag, ipaalam sa amin kung gusto mong ito ay maging regular na order. Nangangahulugan iyon na ipadadala namin ang parehong mga dokumento sa iyong hiniling na format at wika bawat taon. Maaari ka ring tumawag sa amin upang baguhin o kanselahin ang regular na order. Makikita mo rin ang iyong mga dokumento online sa duals.anthem.com. Kung may mga tanong ka, pakitawagan ang Anthem Blue Cross Cal MediConnect Plan sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes mula 8 a.m. hanggang 8 p.m. ? Libre ang tawag. Para sa karagdagang impormasyon, bisitahin ang duals.anthem.com. 2 Anthem Blue Cross Cal MediConnect Plan HANDBOOK NG MIYEMBRO TALAAN NG MGA NILALAMAN Kabanata 1: Pagsisimula bilang miyembro ......................................................................................... 5 Kabanata 2: Mahahalagang numero ng telepono at mapagkukunan ................................................ 17 Kabanata 3: Paggamit sa pagsaklaw ng plan para sa iyong pangangalagang pangkalusugan at iba pang mga saklaw na serbisyo ............................................................................ 38 Kabanata 4: Tsart ng mga Benepisyo .............................................................................................. 62 Kabanata 5: Pagkuha ng iyong mga inireresetang gamot para sa outpatient sa pamamagitan ng plan ....................................................................................................................... 125 Kabanata 6: Ano ang babayaran mo para sa iyong Medicare at Medi-Cal na mga inireresetang gamot ................................................................................................... 146 Kabanata 7: Paghingi sa amin na bayaran ang aming bahagi ng isang bayarin na natanggap mo para sa mga saklaw na serbisyo o gamot ............................................................ 158 Kabanata 8: Ang iyong mga karapatan at pananagutan ................................................................. 164 Kabanata 9: Ano ang dapat gawin kung mayroon kang problema o reklamo (mga desisyon sa saklaw, apela, at reklamo) ......................................................................................... 183 Kabanata 10: Pagwawakas ng iyong pagiging miyembro sa aming Cal MediConnect Plan ........... 249 Kabanata 11: Mga legal na abiso ................................................................................................... 260 Kabanata 12: Mga kahulugan ng mahahalagang salita .................................................................. 263 Kung may mga tanong ka, pakitawagan ang Anthem Blue Cross Cal MediConnect Plan sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes mula 8 a.m. hanggang 8 p.m. ? Libre ang tawag. Para sa karagdagang impormasyon, bisitahin ang duals.anthem.com. 3 Anthem Blue Cross Cal MediConnect Plan HANDBOOK NG MIYEMBRO Mga pagtatatwa ❖ Ang Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) ay isang health plan na nakikipagkontrata sa kapwa Medicare at Medi-Cal upang magkaloob ng mga benepisyo ng kapwa mga programa sa mga nagpatala. ❖ Ang saklaw sa ilalim ng Anthem Blue Cross Cal MediConnect Plan ay kuwalipikadong saklaw sa kalusugan na tinatawag na “pinakamababang mahalagang saklaw.” Tinutugunan nito ang kailangan na indibidwal na nakabahaging responsibilidad ng Patient Protection and Affordable Care Act (ACA). Bisitahin ang website ng Internal Revenue Service (IRS) sa www.irs.gov/Affordable-Care-Act/Individuals-and-Families para sa karagdagang impormasyon tungkol sa kinakailangan sa nakabahaging responsibilidad ng indibidwal. ❖ Ang Anthem Blue Cross ay ang pangalang pangkalakal para sa Blue Cross of California. Ang Anthem Blue Cross at Blue Cross of California Partnership Plan, Inc. ay mga malayaang nabigyan ng lisensya ng Blue Cross Association. Ang ANTHEM ay isang nakarehistrong tatak-pangkalakal ng Anthem Insurance Companies, Inc. Kung may mga tanong ka, pakitawagan ang Anthem Blue Cross Cal MediConnect Plan sa 1-855-817-5785 (TTY: 711), Lunes hanggang Biyernes mula 8 a.m. hanggang 8 p.m. ? Libre ang tawag. Para sa karagdagang impormasyon, bisitahin ang duals.anthem.com. 4 Anthem Blue Cross Cal MediConnect Plan HANDBOOK NG MIYEMBRO Kabanata 1: Pagsisimula bilang miyembro Panimula Kasama sa kabanatang ito ang impormasyon tungkol sa Anthem Blue Cross Cal MediConnect Plan, isang planong pangkalusugan na sinasaklaw ang lahat ng iyong mga serbisyo sa Medicare at Medi-Cal, at ang iyong pagiging miyembro dito. Sinasabi rin dito kung ano ang dapat mong asahan at kung anong iba pang impormasyon ang makukuha mo mula sa Anthem Blue Cross Cal MediConnect Plan. Makikita ang mga mahahalagang termino at ang kanilang mga kahulugan sa pagkakasunud-sunod ayon sa alpabeto sa huling kabanata ng Handbook ng Miyembro. Talaan ng mga Nilalaman A. Maligayang pagdating sa Anthem Blue Cross Cal MediConnect Plan ........................................... 7 B. Impormasyon tungkol sa Medicare at Medi-Cal ............................................................................. 7 B1. Medicare .................................................................................................................................. 7 B2. Medi-Cal .................................................................................................................................. 7 C. Mga Kalamangan ng plan na ito .................................................................................................... 8 D. Lugar na sineserbisyuhan ng Anthem Blue Cross Cal MediConnect Plan .................................... 9 E. Paano ka magiging karapat-dapat upang maging miyembro ng plan ............................................. 9 F. Ano ang dapat asahan sa una mong pagsali sa planong pangkalusugan .................................... 10 G. Ang Iyour Pangkat ng Pangangalaga at Plano ng Pangangalaga ................................................ 11 G1. Pangkat ng Pangangalaga
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