Important FIDA Information
The HIPAA Privacy Notice (.pdf) describes how medical information about you may be used and disclosed and how you can get access to this information.
Rights and Responsibilities
You have a right to get information in a way that meets your needs
We must tell you about Fidelis Care FIDA Plan benefits and your rights in a way that you can understand. We must tell you about your rights each year that you are a Participant in Fidelis Care FIDA Plan. We must also tell you about all of your rights and how to exercise your rights in writing prior to the effective date of coverage.
You have the right to receive timely information about Fidelis Care FIDA Plan changes. This includes the right to receive annual updates to the Marketing, Outreach and Participant Communications materials. This also means you have the right to receive notice of any significant change in the way in which services are provided to you at least 30 days prior to the intended effective date of the change.
You have the right to have all plan options, rules, and benefits fully explained, including through the use of a qualified interpreter if needed. To get information in a way that you can understand, please call Participant Services. Fidelis Care FIDA Plan has people who can answer questions in different languages. We can also give you information in other formats such as Braille, audio, and large print. This information is free.
» If you are having trouble getting information from Fidelis Care FIDA Plan because of language problems or a disability and you want to file a grievance, call Medicare at 1-800-MEDICARE (1-800-633-4227). You can call 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. To file a grievance with the New York State Department of Health (NYSDOH), call the NYSDOH Helpline at 1-866-712-7197.
Tiene derecho a obtener información de una manera que se ajuste a sus necesidades.
Debemos informarle sobre los beneficios de Fidelis Care FIDA Plan y sus derechos de una manera que usted comprenda. Debemos informarle sobre sus derechos todos los años y que usted es un participante en Fidelis Care FIDA Plan. También debemos informarle sobre todos sus derechos y cómo ejercerlos por escrito antes de la fecha de vigencia de su cobertura.
Usted tiene derecho a recibir información acerca de los cambios en el Fidelis Care FIDA Plan de manera oportuna. Esto incluye el derecho a recibir actualizaciones anuales de los materiales de Mercadotecnia, Divulgación y Avisos para participantes. Esto también significa que tiene derecho a recibir notificaciones sobre cualquier cambio significativo en la forma en que los servicios se ofrecen al menos 30 días antes de la fecha prevista de entrada en vigencia del cambio.
Tiene derecho a recibir explicaciones exhaustivas de todas las opciones de planes, las reglas y los beneficios, incluso mediante el uso de un intérprete certificado si fuera necesario. Para obtener información de una manera que pueda entender, llame a los Servicios para participantes. Fidelis Care FIDA Plan cuenta con personas que pueden responder sus preguntas en distintos idiomas. También podemos darle información en otros formatos, como Braille, en audio y en letra grande. Esta información es gratuita.
Si tiene alguna dificultad para obtener información de Fidelis Care FIDA Plan debido a problemas relacionados con el idioma o una discapacidad, y desea presentar una queja, llame a Medicare al 1-800-MEDICARE (1-800-633-4227). Puede llamar las 24 horas del día, los 7 días de la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. Para presentar una queja al Departamento de Salud del Estado de Nueva York (NYSDOH), llame a la línea de ayuda del NYSDOH al 1-866-712-7197.
Вы имеете право получать информацию удобным вам способом.
Мы обязаны проинформировать вас о преимуществах Fidelis Care FIDA Plan и ваших правах в понятной вам форме. Мы обязаны информировать вас о ваших правах каждый год, пока вы являетесь участником Fidelis Care FIDA Plan. Мы также обязаны письменно проинформировать вас обо всех ваших правах и о том, как их применять, до начала срока действия программы.
Вы имеете право своевременно получать информацию об изменениях Fidelis Care FIDA Plan. Сюда входит право получения ежегодных обновлений материалов по маркетингу, социальным программам и общению с участниками. Это также означает, что у вас есть право на получение уведомления о любом значительном изменения способа предоставления вам услуг как минимум за 30 дней до вступления такого изменения в силу.
Вы имеете право получить полное объяснение всех вариантов, правил и преимуществ плана, при этом вам будет предоставлен квалифицированный переводчик, если требуется. Для получения информации в понятной вам форме, позвоните в службу по работе с участниками. В Fidelis Care FIDA Plan работают сотрудники, которые могут отвечать на вопросы на разных языках. Мы также можем предоставить вам информацию в других форматах, например, выполенную шрифтом Брайля, в виде звукозаписи или напечатанную крупным шрифтом. Эта информация бесплатна.
Если у вас возникли сложности с получением информации от Fidelis Care FIDA Plan из-за языкового барьера или ограниченных возможностей, и вы хотите подать жалобу, позвоните в Medicare по номеру 1-800-MEDICARE (1-800-633-4227). Звонки принимаются круглосуточно, без выходных. Пользователи телетайпа должны позвонить по номеру 1-877-486-2048. Чтобы подать жалобу в Департамент здравоохранения штата Нью-Йорк (NYSDOH), позвоните по телефону доверия NYSDOH 1-866-712-7197.
Ou gen dwa pou jwenn enfòmasyon nan yon fason ki satisfè bezwen w yo
Nou dwe enfòme w sou avantaj Fidelis Care FIDA Plan ak dwa w yo nan yon mannyè ou ka konprann. Nou dwe enfòme w sou dwa w chak ane pou w se yon Patisipan nan Fidelis Care FIDA Plan. Nou dwe enfòme w tou sou tout dwa w yo ak kijan pou egzèse dwa w yo alekri anvvan dat asirans la kòmanse.
Ou gen pou dwa resevwa enfòmasyon alè sou chanjman nan Fidelis Care FIDA Plan. Sa gen ladann dwa pou resevwa mizajou chak ane ki genyen nan materyèl Maketing, Sansiblizasyon ak Kominikasyon Patisipan. Sa vle di tou ou gen dwa pou resevwa avi sou nenpòt gwo chanjman nan fason w ap resevwa sèvis pou pi titi 30 jou anvan dat efektif ki prevwa pou chanjman an.
Ou gen dwa pou genyen tout opsyon, règ ak avantaj plan yo esplike nan tout detay yo, ansanm ak itilizasyon yon entèprèt kalifye si nesesè.. Pou jwenn enfòmasyon nan yon mannyè ou ka konprann, tanpri rele Sèvis Patisipan. Fidelis Care FIDA Plan gen moun ki ka reponn kesyon nan diferan lang. Nou ka ba w ou tou enfòmasyon nan lòt fòma tankou Bray, odyo ak papye enprime ak gwo lèt. Enfòmasyon sa yo gratis.
Si w gen pwoblèm pou jwenn enfòmasyon nan Fidelis Care FIDA Plan akòz yon pwoblèm lang oswa enfimite epi w vle pote plent, rele Medicare nan
1-800-MEDICARE (1-800-633-4227). Ou kapab rele 24 è sou 24, 7 jou sou 7. Itilizatè TTY dwe rele 1-877-486-2048. Pou pote yon plent nan Depatman Sante Eta New York (NYSDOH), rele Liy Asistans NYSDOH la nan 1-866-712-7197.
Lei ha il diritto di ricevere le informazioni nelle modalità che meglio si adattano alle sue esigenze
Dobbiamo informarla dei vantaggi offerti dal Fidelis Care FIDA Plan e dei suoi diritti con modalità a lei consone. Dobbiamo informarla dei suoi diritti ogni anno in cui partecipa al Fidelis Care FIDA Plan. Dobbiamo inoltre informarla di tutti i suoi diritti e di come esercitarli, in forma scritta, prima dell’inizio della copertura effettiva.
Lei ha il diritto di ricevere le informazioni relative alle tariffe del Fidelis Care FIDA Plan in modo puntuale. Ha inoltre il diritto di ricevere rapporti annuali relativi ai materiali di marketing, di promozione e di comunicazione con i partecipanti. Ciò significa che ha anche il diritto a ricevere informazioni su tutti i cambiamenti importanti relativi alle modalità di erogazione del servizio almeno 30 giorni prima della data di fatturazione effettiva.
Ha il diritto di conoscere in dettaglio tutte le opzioni del piano, le regole e i vantaggi, compreso il servizio di un interprete qualificato in caso di bisogno. Lei ha il diritto di ricevere le informazioni nelle modalità che meglio si adattano alle sue esigenze, la preghiamo di contattare i Participant Services. Fidelis Care FIDA Plan dispone di personale che può rispondere alle domande in diverse lingue. Possiamo anche fornirle le informazioni in altri formati, per esempio Braille, audio e stampa a caratteri grandi. Queste informazioni sono gratuite.
Se avesse problemi a ottenere le informazioni da Fidelis Care FIDA Plan a causa di problemi linguistici o di una disabilità e volesse presentare un reclamo, contatti Medicare al numero 1-800-MEDICARE (1-800-633-4227). Può chiamare 24 ore su 24, 7 giorni su 7. Gli utenti TTY devono chiamare il numero 1-877-486-2048. Per presentare un reclamo al New York State Department of Health (NYSDOH), chiamare la Helpline del NYSDOH al numero 1-866-712-7197.
귀하께서는 필요한 정보를 취할 권리가 있습니다.
저희는 피델리스 케어(Fidelis Care) FIDA 플랜 혜택에 대해 귀하께서 이해하실 수 있도록 설명드릴 임무가 있습니다. 귀하께서 가입하고 계신 피델리스 케어 FIDA 플랜에 대한 매 연도 귀하의 권리 또한 설명드려야 합니다. 또한 저희는 귀하의 모든 권리에 대해서 설명드려야 하며 플랜이 효력을 발휘하기 이전에 서면으로 귀하의 권리를 행사하는 방법을 알려드려야 합니다.
귀하께서는 피델리스 케어 FIDA 플랜 변경 사항을 적절한 시기에 통보 받으실 권리가 있습니다. 마케팅, 대외 활동, 및 가입자 통신 자료등에 대한 연간 업데이트도 귀하의 권리에 포함됩니다. 이것은 어떠한 중대한 변경이 있을 시 그 변경에 대한 효력 발생 전 적어도 30일 이전에 그러한 변경에 대한 통보를 받을 권리가 있다는 의미입니다.
귀하께서는 필요한 경우 자격 있는 통역사를 통하여 모든 플랜 옵션과 규정 그리고 혜택을 완전히 설명받을 수 있는 권리가 있습니다. 귀하께서 이해할 수 있는 정보를 입수하고자 하시면 가입자 서비스에 연락하여 주십시오. 피델리스 케어 FIDA 플랜은 여러 가지 언어로 질문에 대답할 수 있는 직원들을 두고 있습니다. 저희는 또한 점자나 오디오 또는 큰 활자등 다른 양식으로 정보를 제공할 수 있습니다. 이러한 정보는 무료입니다.
만일 귀하께서 언어 문제나 장애로 인하여 피델리스 케어 FIDA 플랜으로부터 이러한 정보를 입수하는 데 애로 사항이 있으시거나 또는 불만 사항을 신고하시려면 1-800-MEDICARE (1-800-633-4227)번으로 메디커어에 연락하시기 바랍니다. 이 번호는 주 7일 하루 24 시간 이용하실 수 있습니다. TTY 이용자는1-877-486-2048번으로 전화 주시기 바랍니다. 뉴욕 보건부(NYSDOH)에 불만 사항을 신고하시려면1-866-712-7197번으로 NYSDOH 헬프 라인에 연락하시기 바랍니다.
我們必須以您可以理解的方式通告您有關Fidelis Care FIDA計劃的福利和您的權利。衹要您是 Fidelis Care FIDA 計劃的成員，我們每年都必須通告您有關您的權利的信息。我們還必須在保險生效期之前，以書面的方式通告您的權利以及如何使用您的權利。
您有權獲得Fidelis Care FIDA計劃變更的最新信息。這包括有權獲得市場營銷，對外擴展和成員通信的年度更新材料。這意味著您有權在計劃變更生效期的至少30日前收到變更通知。
您有權獲得對所有計劃選項和福利的全面解釋，包括如有需要使用口譯人員。欲獲取您可以理解的信息，請聯係成員服務部。Fidelis Care FIDA計劃代表可以用不同語言回答問題。我們還可以以其他方式給予您信息，如盲文，音頻和大字體。該信息免費。
如您由於語言問題或殘疾而不能獲取Fidelis Care FIDA 計劃信息，而您想提起申訴，請撥打Medicare電話1-800-MEDICARE (1-800-633-4227)。該號碼每週 7 天、每天 24 小時提供諮詢服務。TTY 使用者請撥打 1-877-486-2048。欲向紐約州衛生局(NYSDOH)提起申訴，請撥打NYSDOH服務熱綫1-866-712-7197。
We must treat you with respect, fairness, and dignity at all times
Fidelis Care FIDA Plan must obey laws that protect you from discrimination or unfair treatment. We do not discriminate against Participants because of any of the following:
Under the rules of Fidelis Care FIDA Plan, you have the right to be free of any form of physical restraint or seclusion that would be used as a means of coercion, force, discipline, convenience, or retaliation. You have the right to not be neglected, intimidated, physically or verbally abused, mistreated, or exploited. You also have the right to be treated with consideration, respect, and full recognition of your dignity, privacy, and individuality.
We cannot deny services to you or punish you for exercising your rights. Your exercising of your rights will not negatively affect the way Fidelis Care FIDA Plan and its providers, New York State, or CMS provide or arrange for the provision of services to you.
» For more information, or if you have concerns about discrimination or unfair treatment, call the Department of Health and Human Services’ Office for Civil Rights at 1-800-368-1019 (TTY users call 1-800-537-7697). You can also call your local Office for Civil Rights at (800) 368-1019, or TDD (800) 537-7697.
» If you have a disability and need help getting care or reaching a provider, call Participant Services. If you have a grievance, such as a problem with wheelchair access, Participant Services can help. You can reach Participant Services at 1-800-247-1447 (TTY: 1-800-695-8544) Monday through Friday, 8 AM to 8 PM.
We must ensure that you get timely access to covered services, items, and drugs
As a Participant of Fidelis Care FIDA Plan these are your rights:
You have the right to receive medically necessary services, items, and drugs as required to meet your needs, in a way that is sensitive to your language and culture, and that is provided in an appropriate care setting, including the home and community.
You have the right to choose a Primary Care Provider (PCP) in Fidelis Care FIDA Plan’s network. A network provider is a provider who works with Fidelis Care FIDA Plan. You can also ask us to have a specialist serve as your PCP.
o Call Participant Services or look in the Provider and Pharmacy Directory to learn which providers are accepting new patients.
You have the right to make decisions about providers and coverage, which includes the right to choose and change providers within our network.
You have the right to go to a gynecologist or another women’s health specialist without getting a referral or prior authorization.
· A referral is approval from your Primary Care Provider to see another Provider. Referrals are not required in Fidelis Care FIDA Plan.
· Prior authorization means that you must get approval from your Interdisciplinary Team (IDT), Fidelis Care FIDA Plan, or another specified provider before you can get certain services, items, or drugs or see an out-of-network provider.
You have the right to access other services that do not require prior authorization, such as emergency and urgently needed care, out-of-area dialysis services, and Primary Care Provider visits. Please see Chapter 4 of the FIDA member handbook for more information on services requiring prior authorization and those that do not.
You have the right to get covered services from network providers within a reasonable amount of time. This includes the right to get timely services from specialists.
You have the right to have telephone access to your providers through on-call services. You also have the right to access the Fidelis Care FIDA Plan Nurse Advice Call Line 24 hours a day, 7 days a week in order to obtain any needed emergency or urgent care or assistance.
You have the right to get your prescriptions filled at any of our network pharmacies without long delays.
You have the right to access care without facing physical barriers. This includes the right to be able to get in and out of a provider’s office, including barrier-free access if you have any disabilities or other conditions limiting your mobility, in accordance with the Americans with Disabilities Act.
You have the right to access an adequate network of primary and specialty providers who are capable of meeting your needs with respect to physical access, as well as communication and scheduling needs.
You have the right to receive reasonable accommodations in accessing care, in interacting with Fidelis Care FIDA Plan and providers, and in receiving information about your care and coverage.
You have the right to be told where, when, and how to get the services you need, including how to get covered benefits from out-of-network providers if the providers you need are not available in Fidelis Care FIDA Plan’s network. To learn about out-of-network providers, see Chapter 3 of the FIDA member handbook.
Chapter 9 of the FIDA member handbook explains what you can do if you think you are not getting your services, items, or drugs within a reasonable amount of time. Chapter 9 of the FIDA member handbook also tells you what you can do if we have denied coverage for your services, items, or drugs and you do not agree with our decision.
We must protect your personal health information
We protect your personal health information as required by federal and state laws.
· You have the right to have privacy during treatment and to expect confidentiality of all records and communications.
· Your personal health information includes the information you gave us when you enrolled in Fidelis Care FIDA Plan. It also includes your conversations with your providers, your medical records, and other medical and health information.
· You have the right to get information and to control how your health information is used. We give you a written notice called the “Notice of Privacy Practice” that tells about these rights. The notice also explains how we protect the privacy of your health information.
· You have the right to request that any communication that contains protected health information from Fidelis Care FIDA Plan be sent by alternative means or to an alternative address.
How we protect your health information
o We are required to release health information to government agencies that are checking on our quality of care.
o We are required to give Medicare and Medicaid your health and drug information. If Medicare or Medicaid releases your information for research or other uses, it will be done according to Federal laws. You have the right to request information on how your health and other information has been released by Fidelis Care FIDA Plan.
You have a right to see your medical records
If you have questions or concerns about the privacy of your personal health information, call Participant Services at 1-800-247-1447 (TTY: 1-800-695-8544). From October 1 to February 14, our office hours are 8:00 a.m. to 8:00 p.m. seven days a week and from February 15 through September 30, our office hours are Monday through Friday, 8:00 a.m. to 8:00 p.m.
We must give you information about Fidelis Care FIDA Plan, its network providers, and your covered services
As a Participant of Fidelis Care FIDA Plan, you have the right to get timely information and updates from us. If you do not speak English, we must give you the information free of charge in a language that you can understand. We must also provide you with a qualified interpreter, free of charge, if you need one during appointments with providers. If you have questions about Fidelis Care FIDA Plan or you are in need of interpreter services, just call us at 1-800-247-1447. This is a free service. Written materials are available in Spanish, Chinese, Russian, Italian, Haitian-Creole, and Korean. We can also give you information in other formats, such as Braille, audio, and large print.
If you want any of the following, call Participant Services:
· Information about how to choose or change plans
· Information about Fidelis Care FIDA Plan, including:
o Financial information
o How Fidelis Care FIDA Plan has been rated by plan Participants
o The number of appeals made by Participants
o How to leave Fidelis Care FIDA Plan
o How to choose or change Primary Care Providers
o The qualifications of our network providers and pharmacies
o How we pay the providers in our network
For a list of providers and pharmacies in Fidelis Care FIDA Plan’s network, see the Provider and Pharmacy Directory. For more detailed information about our providers or pharmacies, call Participant Services, or visit our website at http://www.fideliscare.org/fida.
· Information about covered services, items, and drugs and about rules you must follow, including:
o Services, items, and drugs covered by Fidelis Care FIDA Plan
o Limits to your coverage and drugs
o Rules you must follow to get covered services, items, and drugs
· Information about why a service, item, or drug is not covered and what you can do about it, including:
o Asking us to put in writing why something is not covered
o Asking us to change a decision we made
o Asking us to pay for a bill you have received
Network providers cannot bill you directly
Doctors, hospitals, and other providers in our network cannot make you pay for covered services, items, or drugs. They also cannot charge you if we pay less than the provider charged us or if we don’t pay them at all. You have the right to not be charged any co-payments, premiums, deductibles, or other cost-sharing. To learn what to do if a network provider tries to charge you for covered services, items, or drugs, see Chapter 7 of the FIDA member handbook or call Participant Services.
You have the right to leave Fidelis Care FIDA Plan at any time
No one can make you stay in our plan if you do not want to. You can leave the plan at any time. If you leave Fidelis Care FIDA Plan, you will still be in the Medicare and Medicaid programs. You have the right to get most of your health care services through Original Medicare or a Medicare Advantage plan. You can get your Medicare Part D prescription drug benefits from a prescription drug plan or from a Medicare Advantage plan. You also have the right to get your Medicaid services through other programs including the Program of All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus, Managed Long-Term Care, or Medicaid Fee-For-Service (Original Medicaid).
You have a right to make decisions about your health care
You have the right to know your treatment options and make decisions about your services
You have the right to get full information from your doctors and other health care providers when you get services. You also have the right to have access to doctors and other providers who can meet your needs. This includes providers who can help you meet your health care needs, communicate with you in a way that you can understand, and provide you with services in locations that you can physically access. You may also choose to have a family member or caregiver involved in your services and treatment discussions. You have the right to appoint someone to speak for you about the care you need.
§ Know your choices. You have the right to be told about all the kinds of treatment. You have the right to talk with and receive information from providers on all available treatment options and alternatives, regardless of cost, and to have these options presented in a way you understand.
§ Know the risks. You have the right to be told about any risks involved. You must be told in advance if any service or treatment is part of a research experiment. You have the right to refuse experimental treatments.
§ You can get a second opinion. You have the right to see another provider before deciding on treatment.
§ You can say “no.” You have the right to accept or refuse any treatment. This includes the right to leave a hospital or other medical facility, even if your provider advises you not to. You also have the right to stop taking a drug. If you refuse treatment or stop taking a drug, you will not be dropped from Fidelis Care FIDA Plan. However, if you refuse treatment or stop taking a drug, you accept full responsibility for what happens to you.
§ You can ask us to explain why a provider denied care. You have the right to get an explanation from us if a provider has denied care that you believe you should get.
§ You have the right to receive a written explanation. If covered services, items, or drugs were denied, you have the right to get a written explanation without having to request one.
§ You can ask us to cover a service, item, or drug that was denied or is usually not covered. Chapter 9 of the FIDA member handbook tells how to ask Fidelis Care FIDA Plan or your Interdisciplinary Team (IDT) for a coverage decision.
§ You can participate in your care planning. As a Participant in Fidelis Care FIDA Plan, you will receive an in-person Comprehensive Assessment upon enrollment. You will also meet with your IDT to develop your Person-Centered Service Plan (PCSP) and to update it, when necessary. You have the right to request a new Comprehensive Assessment or an update to your PCSP at any time. For more information, see Chapter 1 of the FIDA member handbook.
§ You have the right to complete and accurate information related to your health and functional status from your provider, your IDT, and Fidelis Care FIDA Plan.
You have the right to say what you want to happen if you are unable to make health care decisions for yourself
Sometimes people are unable to make health care decisions for themselves. Before that happens to you, you can:
§ Fill out a written form to give someone the right to make health care decisions for you.
§ Give your providers written instructions about how you want them to handle your health care if you become unable to make decisions for yourself.
The legal document that you can use to give your directions is called an advance directive. There are different types of advance directives and different names for them. Examples are a living will and a power of attorney for health care. When you enroll in the plan, we will inform you about your right to make an advance directive. You will also be told about this right when your Person-Centered Service Plan is updated.
You do not have to use an advance directive, but you can if you want to. Here is what to do:
§ Get the form. You can get a form from your Primary Care Provider, a lawyer, a legal services agency, or a social worker. Organizations that give people information about Medicare or Medicaid may also have advance directive forms. You can also contact Participant Services to ask for the forms.
§ Fill it out and sign the form. The form is a legal document. You should consider having a lawyer help you prepare it.
§ Give copies to people who need to know about it. You should give a copy of the form to your Primary Care Provider. You should also give a copy to the person you name as the one to make decisions for you. You may also want to give copies to close friends or family members. Be sure to keep a copy at home.
If you are going to be hospitalized and you have signed an advance directive, take a copy of it to the hospital.
§ The hospital will ask you whether you have signed an advance directive form and whether you have it with you.
§ If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one.
Remember, it is your choice to fill out an advance directive or not.
What to do if your instructions are not followed
Fidelis Care FIDA Plan and our providers must honor your instructions. If you have signed an advance directive, and you believe that a provider did not follow the instructions in it, you may file a complaint with the New York State Department of Health Hospital Complaint Line at 1-800-804-5447 or the Managed Long Term Care Technical Assistance Center at 1-866-712-7197.
You have the right to ask for help
Chapter 2 of the FIDA member handbook contains contact numbers for many helpful resources. You have the right to ask for help without interference from Fidelis Care FIDA Plan. You can ask for help from agencies like the Independent Consumer Advocacy Network (ICAN) or the NY State Long Term Care Ombudsman.
There are other resources available to you, including those listed in Chapter 2 of the FIDA member handbook. You have the right to ask for help from the entities listed in Chapter 2 or from any other entity you identify.
You have the right to file a grievance and to ask us to reconsider decisions we have made
Chapter 9 of the FIDA member handbook tells what you can do if you have any problems or concerns about your covered services or care. For example, you could ask us to make a coverage decision, make an appeal to us to change a coverage decision, or file a grievance.
You have the right to get information about appeals and grievances that other Participants have filed against Fidelis Care FIDA Plan. To get this information, call Participant Services.
What to do if you believe you are being treated unfairly or your rights are not being respected
If you believe you have been treated unfairly — and it is not about discrimination for the reasons listed on page 134 of the FIDA member handbook — you can get help in these ways:
§ You can call Participant Services and file a grievance with Fidelis Care FIDA Plan as outlined in Chapter 9 of the FIDA member handbook.
§ You can call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501.
§ You can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048.
§ You can call Medicaid at 1-800-541-2831. TTY users call 1-877-898-5849.
§ You can call the Independent Consumer Advocacy Network (ICAN) at 1-844-614-8800, Monday through Friday, 8 AM to 8 PM (TTY users should call 711).
Under all circumstances, you have the right to file an internal grievance with Fidelis Care FIDA Plan, an external grievance with Medicare or the New York State Department of Health (NYSDOH), or an appeal of any coverage decision. The processes for filing any of these are outlined in Chapter 9 of the FIDA member handbook.
How to get more information about your rights
There are several ways to get more information about your rights:
§ You can call Participant Services.
§ You can contact Medicare.
· You can visit the Medicare website to read or download “Medicare Rights & Protections.” (Go to http://www.medicare.gov/Publications/Pubs/pdf/11534.pdf.)
· Or you can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days
a week. TTY users call 1-877-486-2048.
§ You can call the Independent Consumer Advocacy Network (ICAN), at 1-844-614-8800, Monday through Friday, 8 AM to 8 PM (TTY users should call 711).
How to get help understanding your rights or exercising them
You can call the Independent Consumer Advocacy Network (ICAN), at 1-844-614-8800, Monday through Friday, 8 AM to 8 PM (TTY users should call 711). ICAN provides free information and assistance. It is not affiliated with our plan.
You have the right to suggest changes
You have the right to recommend changes in policies and services to Fidelis Care FIDA Plan, Medicare, the New York State Department of Health, or any outside representative of your choice.
You also have responsibilities as a Participant of Fidelis Care FIDA Plan
As a Participant of Fidelis Care FIDA Plan, you have a responsibility to do the things that are listed below. If you have any questions, call Participant Services.
§ Read the Participant Handbook to learn what is covered and what rules you need to follow to get covered services, items, and drugs. This includes choosing a Primary Care Provider and using network providers for covered services, items, and drugs. If you don’t understand something, call Participant Services.
· For details about your covered services and items, see Chapters 3 and 4 of the FIDA member handbook. Those chapters tell you what is covered, what is not covered, what rules you need to follow, and what you pay.
· For details about your covered drugs, see Chapters 5 and 6 of the FIDA member handbook.
§ Tell us about any other health or prescription drug coverage you have. Please call Participant Services to let us know.
· We are required to make sure that you are using all of your coverage options when you receive services. This is called coordination of benefits.
· For more information about coordination of benefits, see Chapter 1 of the FIDA member handbook.
§ Tell your Primary Care Provider and other providers that you are enrolled in Fidelis Care FIDA Plan. Show your Fidelis Care FIDA Plan ID card whenever you get services, items, or drugs.
§ Help your Primary Care Provider and other providers give you the best care.
» Call your Primary Care Provider or Care Manager if you are sick or injured for direction right away. When you need emergency care from out-of-network providers, notify Fidelis Care FIDA Plan as soon as possible. In case of emergency, call 911.
· Give your providers the information they need about you and your health. Learn as much as you can about your health problems. Follow the treatment plans and instructions that you and your providers agree on.
· Make sure that your Primary Care Provider and other providers know about all of the drugs you are taking. This includes prescription drugs, over-the-counter drugs, vitamins, and supplements.
· If you have any questions, be sure to ask. Your providers must explain things in a way you can understand. If you ask a question and you do not understand the answer, ask again.
· Understand the role of your Primary Care Provider, your Care Manager, and your Interdisciplinary Team (IDT) in providing your care and arranging other health care services that you may need.
· Participate in the development of your Person-Centered Service Plan (PCSP) with your IDT and keep appointments or notify your Care Manager or IDT if an appointment cannot be met.
§ Be considerate. We expect all of our Participants to respect the rights of other Participants. We also expect you to act with respect in your Primary Care Provider’s office, hospitals, other providers’ offices, and when dealing with Fidelis Care FIDA Plan employees.
§ Pay what you owe. As a Fidelis Care FIDA Plan Participant, you are responsible for paying the full cost of any services, items, or drugs that are not covered by the plan.
If you disagree with your IDT’s decision or Fidelis Care FIDA Plan’s decision to not cover a service, item, or drug, you can make an appeal. Please see Chapter 9 of the FIDA member handbook to learn how to make an appeal.
§ Tell us if you move. If you are going to move, it is important to tell us right away. Call Participant Services.
· If you move outside of our service area, you cannot be a Fidelis Care FIDA Plan Participant. Chapter 1 of the FIDA member handbook tells about our service area. The Enrollment Broker can help you figure out whether you are moving outside our service area and can help you identify alternative Medicare and Medicaid coverage. Also, be sure to let Medicare and Medicaid know your new address when you move. See Chapter 2 of the FIDA member handbook for phone numbers for Medicare and Medicaid.
· If you move within our service area, we still need to know. We need to keep your membership record up to date and know how to contact you.
§ Tell us if you have any changes in your personal information, including your income or assets. You must provide Fidelis Care FIDA Plan with accurate and complete information.
· It is important to tell us right away if you have a change in personal information such as phone number, address, marital status, additions to your family, eligibility, or other health insurance coverage.
· If your assets in bank accounts, cash in hand, certificates of deposit, stocks, life insurance policies, or any other assets change, please notify Participant Services and New York State.
§ Call Participant Services for help if you have any questions or concerns. Let us know about any problems immediately. The phone number is 1-800-247-1447 (TTY: 1-800-695-8544). From October 1 to February 14, our office hours are 8:00 a.m. to 8:00 p.m. seven days a week and from February 15 through September 30, our office hours are Monday through Friday, 8:00 a.m. to 8:00 p.m.
(Updated 9/28/2016) H1916_FC FIDA 16011 Pending