711 (TTY), To Enroll with IEHP .usa-footer .grid-container {padding-left: 30px!important;} The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. IEHP DualChoice (HMO D-SNP) It details the coverage and costs for any Affordable Care Act-compliant health plan. At IEHP, we believe in rewarding our Team Members for their talent and contribution to our mission. After you pay your $505.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. endstream endobj startxref provides the following cost-sharing on drugs. Look on the Extra Help letters you get, or contact the plan to find out your exact costs. endstream endobj startxref Sample Completed SBC | MS Word Format. Summary of Benefits and Coverage (SBC) Templates, Instructions, and Related Materials - for plan years beginning on or after 4/1/17. hbbd```b`` "A$ri " %f=X$L0i&u@d{:d Children with Medi-Cal coverage under the Childrens Health Insurance Program (CHIP) will have a low monthly premium. KtV %PDF-1.5 % (800) 720-4347 (TTY). The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. ol{list-style-type: decimal;} Insurance companies and job-based health plans must provide you with: This information helps you make apples-to-apples comparisons when youre looking at plans. At IEHP, we believe in rewarding our Team Members for their talent and contribution to our mission. Youll also find access to services for those in crisis here. Contact a plan for a Summary of Benefits. We work with community partners and the courts to bring families together. We do not offer every plan available in your area. Advantage Plus benefits and premiums . We only use data released publicly each year. In addition to the benefits that come with your plan, you can choose to buy a supplemental benefit package called Advantage Plus. x}koH?5,H=Ht.cX(lmKIM7:XHxhGRyj'}wz/n6}~ya~Z=r~~}o~*,)7X0)K2x""-UerS/L[eo~=Kf|?~Vf\+yEr f|3),-$B:. All Rights Reserved. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 4 0 obj ? 324 0 obj <> endobj The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Medicare has neither approved nor endorsed any information on this site. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. Every child deserves a stable, safe, and supportive family. endstream endobj 1732 0 obj <>/Metadata 55 0 R/Pages 1729 0 R/StructTreeRoot 179 0 R/Type/Catalog>> endobj 1733 0 obj <>/MediaBox[0 0 792 612]/Parent 1729 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1734 0 obj <>stream We believe in helping YOU take care of yourself and your family. hb```f``: Ab@cj[_d9^7'g\gW-]i.jgW=`);,:L::;:X3:::::;$PEGv+1[X Yes. IEHP DualChoice Cal MedConnect Plan (Medicare-Medicaid Plan): Summary of Benefits 2022 If you have questions , please call IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. Restaurant Meals Program Vendor Information. also provides the following benefits. A short, plain-language Summary of Benefits and Coverage (SBC), A Uniform Glossary of terms used in health coverage and medical care. * For more information about limitations and exceptions, see the plan or policy document at www.ufcwnationalfund.org. NOTE: Information about the cost of this plan (called the premium) will be provided separately. endobj You may also call Health Care Options at 1-800-430-4263or visit www.healthcareoptions.dhcs.ca.gov. =========== TABBED SINGLE CONTENT GENERAL, People who live in our service area (Riverside and San Bernardino counties), Adults with or without children, children, seniors, and people with a disability, People who meet income guidelines and other program requirements. IEHP DualChoice (HMO D-SNP) /*--> is offered in the following locations. Summary of Benefits and Coverage (SBC) An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. Contact the plan for details. Community is built on trust. Welcome to Summary of Benefits and Coverage (SBC) document posting site for Medical and Dental documents. You need a roof over your head. This is a summary of health services covered by IEHP DualChoice (HMO D-SNP), a Medicare Medi-Cal Plan, for January 1, 2023 through December 31, 2023. %PDF-1.5 % hYmOH+qn[Z!ff{]&1`ms~XvwWU=OU]GJ*bf**mB5Tp38h&d*C t%]3L0eb6R1,1y;H$H$RZ*SJi6ZMbRl*,vj-(YO9VY!swc>=;+4I1GkWWL W''5hJXzxqu*NNhO.i)?9YV,:.9?1S&eLi.7tz1A59gAG=\?IqK5+]YjtRG|4OG43TET~o7tA)4 ? Your HBA, usually located in your agency's personnel office, can also print you a copy . %%EOF endstream endobj startxref wT].b`bd` FI? IEHP DualChoice (HMO D-SNP) 1175 0 obj <> endobj With our. Some of the services listed are covered only if IEHP or your IPA approves first. We offer cash and housing assistance, such as access to hotel/motel vouchers. Insurance companies and job-based health plans must provide you with: A short, plain-language Summary of Benefits and Coverage (SBC) A Uniform Glossary of terms used in health coverage and medical care This information helps you make "apples-to-apples" comparisons when you're looking at plans. 3 0 obj You can connect here with some of the organizations we partner with! All insurance agents and enrollment platforms linked to this site have their own terms and conditions. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} We can give you job training opportunities, employment assistance, and access to rewarding careers that support individuals and families. Learn more about how your agency or business can join our the team that strengthens individuals and communities. See the . 1750 0 obj <>/Filter/FlateDecode/ID[<75972DCB528687409DA200AFE706D977>]/Index[1731 70]/Info 1730 0 R/Length 102/Prev 610410/Root 1732 0 R/Size 1801/Type/XRef/W[1 3 1]>>stream Were here to help! Evidence of Coverage. All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan's unique terms. The SBC shows you how you and the plan would share the cost for covered health care services. -l Outpatient (Ambulatory) Services Physician services Hospital outpatient & outpatient clinic services Outpatient surgery (Includes anesthesiologist services.) 2023 Open Enrollment is over, but you may still be able to enroll in 2023 health insurance through a Special Enrollment Period. We have resources that help prevent abuse and neglect against children and adults, but we need people like you to report suspected abuse or neglect. After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs. 7500 Security Boulevard, Baltimore, MD 21244. We are proud to announce that we help 1 million people in Riverside County each year by offering vital services and programs that support and protect the health, safety, and wellbeing of children, adults, and families in our communities. %%EOF Call 1-877-354-4611 TTY 711, $10.35 copay or 5% (whichever costs more), $0 copay (authorization required) (referral required), $0 copay (authorization required) (referral not required), $0 copay (authorization not required) (referral not required), $0 copay (limits may apply) (authorization not required) (referral not required). The SBC shows you how you and the plan would share the cost for covered health care services. p.usa-alert__text {margin-bottom:0!important;} Advantage Plus gives you extra coverage for an additional monthly cost that's added to your monthly plan premium. The SBC shows you how you and the plan would share the cost for covered health care services. For those struggling with low income, we offer assistance programs for food, cash, housing and health coverage. 1218 0 obj <>stream You can become the loving parent a child needs and deserves. Share via LinkedIn. This is only a summary. This is only a summary. We also have partners throughout Riverside County waiting to help you at any time. (800) 718-4347 (TTY), IEHP DualChoice Member Services (877) 273-4347 #block-googletagmanagerheader .field { padding-bottom:0 !important; } If you need a paper copy, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical Program. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer. Click here to learn more. Copy Page Link. hYioH+ 3"> >Ivg@K, IEHP - Medi-Cal California Medical Insurance Requirements : Welcome to Inland Empire Health Plan \. Summary of Benefits and Coverage (SBC) Template | MS Word Format. The SBC shows you how you and the plan would share the cost for covered health care services. We want the best for our communities, so we are eager to collaborate with innovative partners who share our dedication to improving the health, safety, and wellbeing of individuals and families! It covers families with children, seniors, persons with disabilities, foster care children, pregnant women, and low-income people with specific diseases. Once you reach that amount, you will enter the next coverage phase. In fact, its our top priority. You may also qualify for Extra Help on drug costs. is a Medicare Advantage (Part C) Special Needs Plan by IEHP DualChoice. F|]u_>6|hWoU`z^b>ZMTvYMuzut/u!\z ,d$oS!*y(bS96DbX}IZ7o=e"0]-X]$`WRQ\LB6:P$CT/Y"~&! The site is secure. 1731 0 obj <> endobj Health care is crucial for you and your family. A summary of benefits and coverage (SBC) is a document that all insurance companies are required to provide. Please click here to learn more about our departments various programs, what they can do for you, and how to contact us. Essential Health Benefits Summary A one-page Essential Health Benefits Summary is available for download. We understand that our services and benefits are vital to you. No matter the insurance provider, all SBCs outline the same basic information. L.A. Care Covered Gold 80 HMO Evidence of . Because we respect your right to privacy, you can choose not to allow some types of cookies. 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