To not be discriminated against due to race color national origin or health

To not be discriminated against due to race color

This preview shows page 90 - 92 out of 117 pages.

To not be discriminated against due to race, color, national origin or health status or the need for health care services To have the right to request a second opinion To be notified at the time of enrollment and annually of disenrollment rights Other Participant rights and protections, as specified in 42 CFR § 438.100 To make an Advance Directive To file any complaint about not following Advance Directives with the Pennsylvania Department of Health To choose a Provider who gives care whenever possible and appropriate To receive accessible healthcare services comparable in amount, duration and scope to those provided under Medicaid FFS and sufficient in amount, duration and scope to be reasonably expected to achieve the purpose for which the services are furnished To receive appropriate services not denied or reduced solely because of diagnosis, type of illness or medical condition Freedom to exercise the rights described herein without any adverse effect on the treatment by Pennsylvania Department of Health, PA Health & Wellness, its providers or contractors To receive all written participant information from PA Health & Wellness: o o o At no cost to the Participant In the prevalent non-English languages of Participants in the service area In other ways, to help with the special needs of Participants who may have trouble reading the information for any reason To receive oral interpretation services free of charge for all non-English languages, not just those identified as “prevalent” To be notified that oral interpretation services are available and how to access them To get help from both Pennsylvania Department of Health and its Enrollment Broker in understanding the requirements and benefits of PA Health & Wellness
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90 Participant Responsibilities Participants have certain responsibilities: o o A description of procedures to follow if: Participant family size changes Participant moves out of the Region, out-of-state or have other address changes Participant obtains or has health coverage under another policy, other third party, or there are changes to that coverage Allow PA Health & Wellness direct access (not via vendor) to medical records for the purpose of data collection initiatives, such as HEDIS and other contractual, regulatory or other programs To take actions toward improving their own health, their responsibilities and any other information deemed essential by PA Health & Wellness Information about the process that participants and providers must follow when requesting non-emergent inpatient hospitalization Prior Authorization, including how to notify PA Health & Wellness of an inpatient admission for non-emergent care Information on any of cost-sharing responsibilities To inform PA Health & Wellness of the loss or theft of a participant ID card To present participant ID card(s) when using healthcare services To be familiar with PA Health & Wellness procedures and coverage rules and restrictions to the best of the Participant’s abilities
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  • Fall '19
  • PA Health & Wellness

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