Medi-Cal Member Handbook - LA Care Health Plan

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Medi-Cal Member Handbook / Benefit Year 2010-2011 Medi-Cal Estate Recovery Program ..................................................................................47 Disruption in services.........................................................................................................48 Organ donation....................................................................................................................48 What is an advance directive?...........................................................................................48 New technology...................................................................................................................48 Glossary of Terms ..........................................................................................................................49 Important Phone Numbers ............................................................................................................55 vi Anthem Blue Cross Customer Care Center toll-free 1-888-285-7801 L.A. Care Health Plan Member Services Department toll-free 1-888-839-9909
WELCOME: Thank you for choosing L.A. Care Health Plan! L.A. Care is a government agency that was created over 10 years ago to help Los Angeles County Medi-Cal members get quality health care. L.A. Care is also called the Local Initiative Health Authority for Los Angeles County. But you can call us “L.A. Care.” With the help of the health plans we work with, L.A. Care serves nearly 800,000 members in Los Angeles County. We only serve people who live in Los Angeles County (called our “service area”). L.A. Care Health Plan is the largest public health plan in the nation. We are growing because we are a trusted source for health care and we respect our members. When your care starts To enroll in the Medi-Cal program, call or visit the Los Angeles County Department of Public Social Services office (DPSS) near you. Once DPSS finds you eligible, you can enroll in a health plan of your choice. Enrollment in a health plan can take between 15 to 45 days. While your enrollment in a health plan is processed, you can access your Medi-Cal benefits using the Benefits Identification Card (BIC) sent to you by the California Department of Health Care Services. The benefits you access during this time are covered by Medi-Cal. Your care through L.A. Care and Anthem Blue Cross starts when your enrollment in a health plan is complete. You can start using your Medi- Cal benefits through L.A. Care and Anthem Blue Cross on your effective date of coverage. Your effective date of coverage is the 1 st day of the Medi-Cal Member Handbook / Benefit Year 2010-2011 month following completion of enrollment in a health plan. Check the Anthem Blue Cross member ID card mailed to you for the effective date of coverage. Your health plan choices with L.A. Care L.A. Care works with five (5) Health Plan Partners to provide health care services for members. L.A. Care and the Health Plan Partners have contracts with many doctors, hospitals, pharmacies and other health care providers to serve you. When a Medi-Cal member joins L.A. Care, the member can choose to receive services through: Anthem Blue Cross Care1st Health Plan Community Health Plan Kaiser Permanente L.A. Care Health Plan L.A. Care and the Health Plan Partners are prepaid health coverage programs called “health maintenance organizations,” or HMOs. L.A. Care and the Health Plan Partners are licensed with the State of California. The State of California has given L.A. Care and the Health Plan Partners permission to serve you. The State of California pays for your health care. There is no cost to you when you get services covered by Medi-Cal. When you chose L.A. Care for your Medi-Cal, you also chose Anthem Blue Cross as your health plan. (If you did not choose a health plan, we chose one for you.) Anthem Blue Cross is responsible for almost all of your health care services. Some benefits, like dental and vision, are not provided by your health plan. You can learn more about this in the “More benefits: What other services can I get?” section of this handbook. 1 Anthem Blue Cross Customer Care Center toll-free 1-888-285-7801 L.A. Care Health Plan Member Services Department toll-free 1-888-839-9909
Page 1: Medi-Cal Member Handbook Benefit Ye
Page 5: Dear Member: Welcome to your health
Page 8 and 9: Get Answers from 24/7 NurseLine •
Page 11 and 12: As an L.A. Care/Anthem Blue Cross m
Page 13 and 14: Benefit Year 2010-2011 Medi-Cal Mem
Page 15 and 16: Medi-Cal Member Handbook / Benefit
Page 17: Medi-Cal Member Handbook / Benefit
Page 21 and 22: This Member Handbook: Why is it imp
Page 23 and 24: Let’s get started: How do I get h
Page 25 and 26: time they found out about your Medi
Page 27 and 28: ID Cards: How do I use them? What t
Page 31 and 32: How to keep seeing your doctor if y
Page 35 and 36: Anthem Blue Cross’ network. You d
Page 37 and 38: Maternity care Maternity care inclu
Page 39 and 40: You can get confidential STD servic
Page 41 and 42: More benefits: What other services
Page 45 and 46: Pharmacy benefits: How do I get pre
Page 47 and 48: Your doctor Medi-Cal Member Handboo
Page 49 and 50: What to do in an emergency Call 911
Page 51 and 52: state and local government services
Page 53 and 54: You can also file a grievance onlin
Page 55 and 56: You must first go through the Anthe
Page 59 and 60: Before L.A. Care or Anthem Blue Cro
Page 61 and 62: Medi-Cal: How can I make sure I don
Page 63 and 64: If you are disenrolled from L.A. Ca
Page 65 and 66: More important information: What el
Page 67 and 68: Glossary of Terms This glossary wil
Page 69 and 70:
Food and Drug Administration (FDA)
Page 71 and 72:
Out-of-area services are emergency
Page 73 and 74:
Important Phone Numbers Medi-Cal Ha
Page 75:
Other Things to Know About Your Hea
Page 79:
If you are pregnant, call us right
Page 82 and 83:
24/7 NurseLine Mensajes Grabados En
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1907 Heart Failure 1908 Atrial Fibr
Page 86 and 87:
2164 Laparoscopy 2165 Ear Tubes 217
Page 88 and 89:
Guidelines for Healthy Children and
Page 90 and 91:
Guidelines for Pregnant Women The c
Page 92 and 93:
Guidelines for Healthy Adults Adult
Page 94 and 95:
These guidelines may have changed s
Page 96 and 97:
HOW WE MAY USE AND SHARE INFORMATIO
Page 98 and 99:
• You and your personal represent
Page 100 and 101:
Or Secretary of the U.S. Department
Page 102:
BUSINESS REPLY MAIL FIRST-CLASS MAI
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