Commonwealth Care Member Guide - BMC HealthNet Plan

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PREMIUMS AND CO-PAYMENTS Some members may have a premium. A premium is what you must pay to the Health Connector as part of the cost of your BMC HealthNet Plan coverage. - You must send your monthly payments to the Health Connector. Call the Health Connector with any premium questions. - If you have trouble paying your premium, call the Health Connector. If you stop paying, you may lose your coverage. Premium and co-payment hardship waivers are available through the Health Connector for some enrollees. Call the Health Connector with your premium questions. Their number is 1-877-623-6765. A co-payment is what you pay directly to a healthcare provider for a health service when you receive the service. There is an out-of-pocket co-payment maximum. This means that you will only have to pay a certain total amount of co-payments each year. Co-payments are usually due at the time of service. DO NOT SEND MONEY TO BMC HEALTHNET PLAN. REFERRALS AND PRIOR-AUTHORIZATIONS REMEMBER: YOUR PCP DELIVERS OR COORDINATES YOUR CARE. REFERRALS TO PROVIDERS - You always need a referral from your PCP to see an out-of-network provider. Your PCP must call BMC HealthNet Plan to make sure that we approve the referral. BMC HealthNet Plan may direct you to see a different provider. - In some cases, you need a referral from your PCP before you see an innetwork provider. - You do not need to get a referral for most in-network OB/GYN services. - If you need a referral in advance and do not get one, you may have to pay for the services. PRIOR-AUTHORIZATIONS FOR SERVICES - Your PCP needs to get approval from us before referring you for certain health services. This is called a prior-authorization. 9 CALL MEMBER SERVICES AT 1-877-957-5300 IF YOU HAVE ANY QUESTIONS.
WE CARE ABOUT A HEALTHIER YOU CALL MEMBER SERVICES IF YOU HAVE ANY QUESTIONS ABOUT YOUR COVERAGE OR THE SERVICES YOU GET. THE NUMBER IS 1-877-957-5300. Llámanos 1-877-957-5300. Hãy goi cho chúng tôi 1-877-957-5300. Telefone para nós 1-877-957-5300. Rele nou 1-877-957-5300. Call our 24-hour Nurse Advice Line to get medical and other healthcare information from a highly trained registered nurse. The number is 1-800-765-7344. In an emergency, go to the nearest emergency room or call 911 right away. You do not need a referral or prior-authorization before seeking emergency care. 10
Page 1 and 2: Your Plan for Total Health COMMONWE
Page 3 and 4: GENERAL MEMBER INFORMATION Welcome
Page 5 and 6: BMC HEALTHNET PLAN, COMMONWEALTH HE
Page 7 and 8: You enrolled with BMC HealthNet Pla
Page 9: YOUR PCP Your primary care provider
Page 13 and 14: WAYS TO GET INFORMATION 12
Page 15 and 16: HAVING TROUBLE BALANCING YOUR LIFE
Page 17 and 18: HEALTHY BEHAVIORS WANT TO JOIN A FI
Page 19 and 20: PREPARING TO SEE YOUR HEALTHCARE PR
Page 21 and 22: MEMBER BENEFIT REQUEST (MBR)-An app
Page 24: TO ANSWER ALL YOUR QUESTIONS, OR FI

Commonwealth Care Member Guide - BMC HealthNet Plan

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