Member Handbook 2021 | Ohio Medicaid CareSource | Member Handbook Contact Us Member Services Phone: 1-800-488-0134 (TTY: 1-800-750-0750 or 711) Monday - Friday, 7 a.m. to 7 p.m. Mailing Address: 230 N. Main Street Dayton, Ohio, 45402 Online: CareSource.com The Member Services phone number and website are listed at the bottom of each page of this handbook. CareSource24® Nurse Advice Line: 1-866-206-0554 (TTY: 1-800-750-0750 or 711) CareSource Transportation Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711) Hours of Operation: CareSource is open for business Monday – Friday, 8 a.m. to 5 p.m. CareSource is closed* on: • New Year’s Day - January 1, 2021 • Memorial Day - May 25, 2021 • Independence Day - July 3, 2021 • Labor Day - September 7, 2021 • November 26, 2021 • November 27, 2021 • December 24, 2021 • December 27, 2021 *Our CareSource24® Nurse Advice Line is open 24/7, 365 days a year, along with observed holidays. If youIf have you questions,have questions, please call please Member call Services Member at <1-800-488-0134 Services at 1-800-488-0134 (TTY: 1-800-750-0750 (TTY: or 711) 1-800-750-0750 or 711) I Monday - Friday from 7 a.m. to 7 p.m.> For more information, visit <CareSource.com/OhioMedicaid>. Monday - Friday from 7 a.m. to 7 p.m. For more information, visit CareSource.com/OhioMedicaid. CareSource | Member Handbook Table Of Contents Welcome ........................................................................................................................................................... 2 Continuing Current Treatment Plans And Care ............................................................................................ 3 New Member Information ........................................................................................................................... 3 Current Prescription Coverage................................................................................................................... 3 Your Membership Identification (ID) Card ..................................................................................................... 4 Member Services ............................................................................................................................................. 6 Interpreter Services .................................................................................................................................... 6 CareSource24® Nurse Advice Line ................................................................................................................. 7 My CareSource® ............................................................................................................................................... 7 CareSource Mobile App .................................................................................................................................. 8 Services Covered by CareSource .................................................................................................................. 9 Behavioral Health Services ...................................................................................................................... 10 Dental Services ........................................................................................................................................ 10 Vision Services ......................................................................................................................................... 10 Services Not Covered by CareSource ..................................................................................................... 10 Services Not Covered by CareSource Unless Medically Necessary ........................................................11 Frequency Limitations ...............................................................................................................................11 Benefits .......................................................................................................................................................... 12 Benefits At-A-Glance ................................................................................................................................ 12 Benefits Guide .......................................................................................................................................... 16 Your Primary Care Provider (PCP) ............................................................................................................... 22 Choosing A PCP ....................................................................................................................................... 22 Changing Your PCP ................................................................................................................................. 22 Doctor Appointments ................................................................................................................................ 23 Preventive Care........................................................................................................................................ 23 Where To Get Care ........................................................................................................................................ 24 Primary Care Provider (PCP) ................................................................................................................... 24 Telehealth ................................................................................................................................................. 24 Convenience Care Clinics ........................................................................................................................ 25 Urgent Care Centers ................................................................................................................................ 26 Emergency Services ................................................................................................................................ 26 If you have questions,If you please have questions,call Member please Services call Member at 1-800-488-0134Services at <1-800-488-0134 (TTY: 1-800-750-0750 (TTY: 1-800-750-0750 or 711) or 711) Monday - Friday from 7 a.m. to 7 p.m.> For more information, visit <CareSource.com/OhioMedicaid>. II Monday - Friday from 7 a.m. to 7 p.m. For more information, visit CareSource.com/OhioMedicaid. CareSource | Member Handbook Follow-Up Care (Also Called Post-Stabilization Care) ............................................................................. 27 When You Can See A Non-Network Provider........................................................................................... 27 When You Travel Outside Of Our Service Area........................................................................................ 28 Emergency Or Urgent Care Outside Of Our Service Area ....................................................................... 28 Care Management Services.......................................................................................................................... 29 Additional CareSource Benefits................................................................................................................... 31 CareSource Life Services® ....................................................................................................................... 31 MyStrengthSM ............................................................................................................................................ 31 Express BankingTM ................................................................................................................................... 31 CareSource24® Nurse Advice Line........................................................................................................... 32 Disease Management Program................................................................................................................ 32 KidsHealth® .............................................................................................................................................. 32 MyHealth .................................................................................................................................................. 32 Comprehensive Primary Care (CPC) ....................................................................................................... 32 Transportation (Rides) .............................................................................................................................. 33 Incentives And Rewards ............................................................................................................................... 35 Babies First® ............................................................................................................................................. 35 Kids First .................................................................................................................................................. 36 Women First ............................................................................................................................................. 37 Healthchek ..................................................................................................................................................... 39 Prescription Drugs .......................................................................................................................................