UI Health Plus Member Handbook

Member Handbook

TABLE OF CONTENTS Welcome to UI Health Plus.........................................................................................................1 Discover the Benefits of UI Health Plus............................................................................1 UI Health Plus Contact Information....................................................................................1 Definitions...........................................................................................................................................2 The UI Health Plus Member Service Promise................................................................. 3 Your Member ID Card.................................................................................................................. 3 Primary Care Provider (PCP)................................................................................................... 4 Your Personal Primary Care Provider............................................................................... 4 Changing Your PCP..................................................................................................................4 Contacting Your PCP...............................................................................................................4 Specialty Care.............................................................................................................................5 Second Opinion..........................................................................................................................5 Covered Medical Services6...................................................................................................... 6 Non-Covered Services............................................................................................................. 6 Emergency Care..............................................................................................................................7 Urgent Care........................................................................................................................................7 Important UI Health Plus Services19................................................................................... 8 Making Appointments............................................................................................................. 8 Mental Health and Substance Abuse Services............................................................ 9 Hospitalization............................................................................................................................ 8 Prescriptions................................................................................................................................ 8 Dental Services........................................................................................................................... 8 Vision Services............................................................................................................................ 9 Eye Specialists and Services................................................................................................ 9 Transportation............................................................................................................................. 9 Preventive Services and Health Education...................................................................10 Care Coordination and Disease Management............................................................10 Women’s Health........................................................................................................................10 Well-Baby Care..........................................................................................................................10 Immunizations for Babies...................................................................................................... 11 Member Rights............................................................................................................................... 12 Member Responsibilities.......................................................................................................... 12 Disenrollment Procedures....................................................................................................... 12 Advance Directives (Living Will)......................................................................................... 12 Grievance Procedure................................................................................................................... 12 Appeals..............................................................................................................................................14 UI Health Plus Privacy Notice................................................................................................ 15 Your Health Information Rights............................................................................................16 UI Health Plus Management Policy and Procedure.................................................... 17

WELCOME TO UI HEALTH PLUS Discover the Benefits of UI Health Plus UI Health Plus is a Medicaid managed care plan offered by the University of Illinois Hospital & Health Sciences System (UI Health).

UI Health is dedicated to you, your family and to the community. We know you will discover the UI Health quality difference and benefit from your enrollment in the UI Health Plus program.

As a UI Health Plus member, you can be seen at any of UI Health’s locations—the hospital, outpatient clinics or our Mile Square Health Centers, with 12 convenient locations, including Back of the Yards, Englewood, Cicero, and South Shore. For a full list of our locations, please visit UIHealthPlus.org or call 1.866.600.CARE., please visit UIHealthPlus.org or call 1.866.600.CARE.

UI Health Plus Contact Information Make An Appointment 1.866.600.CARE (2273) Member Services 1.844.810.2273 TTY for the Hearing Impaired 1.844.910.2273 If you need member information in other languages and formats, please contact UI Health Plus Member Services at 1.844.810.2273.

Hay información en español. Llame al 1.844.810.2273.

Website: www.UIHealthPlus.org Member Services Mailing Address: (This is not a location for medical care, this is for mail only.)

UI Health Plus 1240 E. Diehl Road, Suite 100 Naperville, IL 60563

Service Area Information: People enrolled in UI Health Plus are: • Family Health Plan members (children, family and caregivers) • Adults newly eligible for Medicaid under the Affordable Care Act (adults 19-64) • Children with Special Needs UI Health Plus will be available to patients across the City of Chicago, Cicero, Berwyn and Oak Park who live in the following zip codes: 60601, 60602, 60605, 60606, 60607, 60608, 60609,60610, 60611, 60612, 60613, 60614, 60615, 60616, 60617, 60618, 60619, 60620, 60621, 60622, 60623, 60624, 60625, 60626, 60628, 60629, 60630, 60631, 60632, 60633, 60634, 60636, 60637, 60638, 60639, 60640, 60641, 60642, 60643, 60644, 60645, 60646, 60647, 60649, 60651 60652, 60653, 60654, 60655, 60656, 60657, 60659, 60660, 60661, 60706, 60707, 60804, 60827, 60603, 60604 60402, 60301, 60302, 60304, 60804

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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DEFINITIONS Advance Directive: A document that tells your primary care provider and family how you wish to be cared for.

It goes into effect when you are so ill that you cannot make decisions for yourself.

Appeal: A request you make when you do not agree with our decision to deny, reduce and/or end a service.

Someone who represents you can also ask for an appeal. Members file grievances with the health plan, they file appeals with the state.

Benefits: Health care that is covered by UI Health Plus.

Co-pay or Co-payment: The money you pay at the time of services.

Care Coordination: The process by which a health care professional helps you arrange medical care and other services you need.

Inpatient: A person who stays in a hospital for a period of time.

Medically Necessary Services: Medical services that are needed for you to get well and stay healthy.

Member: A person who has joined UI Health Plus.

Out of Network: Health care providers who have not contracted with UI Health Plus to provide care.

Outpatient: A person who is treated does not need to stay overnight in a hospital.

Prescription Medicine: A drug for which your primary care provider writes an order.

Primary Care Provider (PCP): Your personal care provider. He or she manages all your health care needs.

Disenrollment: Steps to follow to leave UI Health Plus.

Durable Medical Equipment: Items such as wheelchairs and oxygen tanks.

Emergency: Any medical problem that could cause death or permanent injury if not treated quickly.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)/Well-Child Visits: Regular health exams for children to find and treat medical problems.

Grievances: When you let us know you are not satisfied with a provider, the plan or a benefit. You can do this in writing or tell us verbally. Someone you choose can file a grievance for you.

HFS: The Illinois Department of Healthcare and Family Services (HFS) is the state agency dedicated to improving the lives of Illinois families through healthcare coverage and child support services. It runs the Medicaid program.

Home Health Agency: A company that provides health care services in your home.

Identification Card: A card that shows you are a member of UI Health Plus.

Immunizations: Shots that keep a child safe from many serious diseases. There are some shots your child must get before they can start day care or school in Illinois.

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Prior Authorization: When HFS needs to approve medical treatment or medicines before you receive them.

Provider: Those trained to give medical care.

This includes physicians, hospitals, pharmacies, laboratories or other medical professionals.

Referral: When your primary care provider (PCP) or Care Manager sends you to see another health care provider.

Specialist: A health care provider who only practices in a specific field of medicine.

Treatment: The care you get from health care providers and facilities. 

THE UI HEALTH PLUS MEMBER SERVICE PROMISE We have a dedicated staff of experienced member service representatives to help you. Call 1.844.810.2273 (toll free) to speak with a member of our staff. We have representatives who speak both English and Spanish. Hay información en español. Llame al 1.844.810.2273.

Our staff will: • Answer questions • Help you make appointments • Send you new UI Health Plus identification cards Did you change your address or phone number? Always contact UI Health Plus Member Services at: 1.844.810.2273. We need your current address to send you important information about your healthcare.

If you want to change your health plan: You can change your health plan anytime in the first 90 days. After that, you cannot change health plans for one year. One time each year, you can change health plans during the time called “open enrollment.”

To learn more about your health plan options, contact Client Enrollment Services at 1.877.912.8880 or TTY: 1.866.565.8576. Or visit www.enrollhfs.illinois.gov.

EXAMPLE OF A MEMBER ID CARD

Member Name: John Doe Medicaid RIN #: 1234567890 Date of Birth: 01-01-54 Effective Date: 09-01-14

Customer Service: 1.844.810.2273 Substance Abuse: 1.844.810.2273

Your Primary Care Provider: Jane Doe M.D. Your Doctor’s Address: 1740 W Taylor Street Chicago, IL 60612 Medical Group: UI Health Plus Member Services #: 1.844.810.2273

For information about your health plan or to reach a member services representative or a Primary Care Provider after-hours, please call 1.844.810.2273 or TTY 1.844.910.2273.

This card does not guarantee eligibility or payment for services.

Medical providers must verify identity and eligibility when you need care.

www.uihealthplus.org

Each member of UI Health Plus receives a Member ID Card. To reach a member services representative, or to be connected with a PCP after- hours, please call 1.844.810.2273 or TTY 1.844.910.2273.

Remember to always carry your UI Health Plus ID Card with you at all times.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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PRIMARY CARE PROVIDER (PCP) When you joined UI Health Plus, you chose a primary care provider (PCP). You can choose a different PCP for each family member. Your PCP can be a: • Family Medicine Physician, who specializes in care for people of all ages.

• Pediatrician, a doctor who specializes in care for children only.

• Internal Medicine Physician, who specializes in care for adults only.

• Nurse Practicioner, who specializes in care for people of all ages.

• Geriatrician, who specializes in care of adults older than 65.

Your Personal Primary Care Provider At UI Health Plus, you have a personal Primary Care Provider (PCP) who will get to know you well and take care of you. He or she can help arrange all of your health care needs.

Your PCP can: • Take care of you when you are sick • Help you manage illnesses and other chronic conditions like diabetes, high blood pressure and asthma • Arrange for lab and X-Ray tests and family planning • Refer you to specialists or other healthcare providers when needed • Admit you to the hospital when needed • Answer questions you have about your healthcare and give you information to stay healthy • Give regular checkups and immunizations (shots) to stay well

Changing Your PCP If you have a problem with your PCP, we would like you to talk to your PCP first to try to work it out. If you are not able to work things out, you may want to change your PCP. If you need help changing your PCP, UI Health Plus Member Services can help you find a new PCP. Call 1.844.810.2273 for more information.

Once you know which PCP you would like to choose, contact Illinois Health Connect at 1.877.912.1999 or TTY: 1.866.565.8577, or go to their website: www.illinoishealthconnect.com.

This may be important if you move and want a PCP closer to your home. UI Health Plus has PCP’s at both the Outpatient Care Center located at 1801 W. Taylor or at the 12 Mile Square Health Center locations. A new Member ID Card will be sent to you with your PCP’s name and phone number on it.

Contacting Your PCP You can reach your PCP by calling UI Health Plus Member Services and they will connect you, or calling directly to your PCP’s office. If your PCP is not available, Member Services will have a “provider on call” who will care for you.

The telephone number is printed on the front of your Member ID Card, or you can call 1.844.810.2273. Remember to carry your UI Health Plus Member ID Card with you at all times.

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Specialty Care Your Primary Care Provider (PCP) can take care of most of your health care needs but some illnesses or conditions may require care from a specialty provider. In this case, your PCP can arrange a referral for the specialty provider and help you make the appointment, if needed.

Behavioral Health Services, such as substance abuse or other mental health conditions can be provided by a Medicaid approved provider. Your PCP or Care Coordinator might refer you to a behavioral health provider. You can also access Family Planning Services in UI Health Plus.

You DO NOT NEED A REFERRAL for the following services: • Services provided by: • Nurse practitioners, midwives, and physician assistants who are not affiliated with a PCP • Podiatrists and chiropractors • Audiologists • Family Planning OB/GYN Services • Services provided to newborns up to 91 days after birth • Emergency Room Services • Emergency and Non-Emergency Transportation • Prescriptions • Dental Services • Speech, Occupational and Physical Therapy • Eye Exams and Services • Shots/Immunizations • Mental Health Services • Drug or Alcohol Treatment • Services to treat sexually transmitted infections • Services to treat tuberculosis • Early Intervention Services • Hospital Services • Home Health Care • Outpatient Ancillary Services (like X-rays or lab tests) • Lead Screening

Second Opinion Your PCP may recommend surgery or diagnose you with a serious medical condition. You may want to discuss this with another provider. If you do, you have the right to ask for a second opinion. Please call UI Health Plus Member Services to ask for a second opinion. UI Health Plus will find a provider to help you. Call 1.844.810.2273 for assistance.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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COVERED MEDICAL SERVICES

NON-COVERED SERVICES

Medicaid covers many medical services for its members. Here is a list of some of the medical services covered.

There are certain services that Medicaid does not cover. These services include:

• Physician services • Hospital Inpatient Services • Hospital Emergency Room Visits • Hospital Ambulatory Services • Ambulatory Surgical Treatment Center Services • Encounter Rate Clinic Visits • Pharmacy Services • Laboratory/X-ray Services • Optical Services/supplies • Chiropractic Services (for children under 21)

• Research procedures: These are procedures or treatments that are also not typical. These types of treatments are still under research.

• Medical examinations required for entrance in to adult educational or vocational program: Certain programs need a medical exam to qualify. These types of exams and tests are not covered.

• Acupuncture: This is a treatment that involves needles being placed in certain parts of the body.

• Optometrist Services

• Autopsy: This is a service that is performed after a person dies. It takes a look at the causes for a person’s death.

• Advanced Practice Nurse Services

• Artificial insemination

• Audiology Services

• Chiropractic services for adults.

• Dental Services

• Medical or surgical procedures performed for cosmetic purposes. These are procedures that do not improve your health. For example, plastic surgery.

• Hospice Services

• Family Planning Services and Supplies • Podiatric Services • Transportation to secure medical services • Long Term Care Services • Home Health Agency Visits • Physical, Occupational, and Speech Therapy Services • Renal Dialysis Services • Medical Supplies, Equipment, Prostheses, and Orthoses • Respiratory Equipment and Supplies

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• Experimental procedures: This is treatment that isn’t typical.

• Medical or surgical transgender treatment services. This is treatment for individuals that want to change gender.

Please note this is not a full list of non-covered services. If you have a question if a service is covered, contact us. We can be reached at 1.844.810.2273.

EMERGENCY CARE In case of an Emergency Medical Condition you should: • Go to the closest emergency room or to the University of Illinois Hospital, or • Call 911 for assistance

Examples of an Emergency Medical Condition include: • Chest pains • High fever • Bleeding that won’t stop • Passing out • Seizures

If you have an emergency, a referral is NOT needed.

In an emergency, you can use any hospital or other provider of emergency services.

An emergency is a health problem that is life threatening or one that will seriously hurt your health if it is not treated right away. Go to the emergency room only if your problem is serious. If it’s not serious, make an appointment to see your PCP or visit UI Health’s Urgent Care Center at 1220 S. Wood Street.

Medicaid covers services provided for an Emergency Medical Condition no matter where you are. If you go to an Emergency Room, you must have someone call UI Health Plus within 24 hours or as soon as reasonably possible. Call 1.844.810.2273 to report an emergency hospital admission. When the medical condition is stable, you may be moved to a hospital that accepts UI Health Plus. The main hospital is located at 1740 West Taylor Street, Chicago, IL 60612.

After an Emergency Medical condition, you must receive all follow-up care through your UI Health Plus Primary Care Provider (PCP). Your Primary Care Provider will help direct and coordinate the follow-up care you need.

• A broken bone • Trouble breathing • Serious burns • Serious stomach pains • Damage to the eyes

URGENT CARE Urgent Care means you need health care soon, but it is not an emergency. Call your PCP or visit UI Health’s Mile Square Urgent Care Center located at 1220 South Wood St. Chicago, IL 60608.

The Urgent Care Center is open: • Monday – Friday, 12:00 p.m. to 8:00 p.m.

• Weekends, 10:00 a.m. to 6:00 p.m.

Examples of urgent care include: • Ear aches • Skin infections • Minor burns or cuts • Bad cold or sore throat • Broken bone

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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IMPORTANT UI HEALTH PLUS SERVICES Making Appointments Please make appointments with your PCP as needed.

This is your regular primary care provider. Your PCP has access to all of your medical records of care you received at UI Health. To make an appointment with your PCP or any other UI Health provider, call: 1.866.600.CARE (2273).

• If you need to cancel your appointment, call your PCP’s office directly.

• If you are going to be late for your appointment, call your PCP’s office to let them know. They may ask you to set up another appointment time.

NEW MEMBERS SHOULD MAKE THEIR FIRST APPOINTMENT NOW! If you selected a new Primary Care Provider (PCP) when you joined UI Health Plus, you should call and make an appointment to meet your PCP and get started on keeping healthy. Make separate appointments for each member of your family.

When you make an appointment, it is important to: • Have your Member ID Card with you.

• Explain why you need an appointment.

• Tell your provider’s office if you need urgent care so you can be seen within 24 hours.

Mental Health and Substance Abuse Services If you need mental health and/or substance abuse services, they can be provided by any Medicaid provider without a referral from your PCP. To contact a professional in our network, call 1.844.810.2273 and our Member Service Staff will connect you with a mental health provider.

Hospitalization If you are not feeling well or think you need to go to the hospital, first call your UI Health Plus PCP. They will tell you what to do. You can reach a PCP at 1.844.810.2273.

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Prescriptions You DO NOT NEED A REFERRAL from your PCP for prescription drug services. Children (under 21) are covered for all medically necessary prescription drugs. Adults who are UI Health Plus members may or may not have their prescriptions covered.

Some people will have to pay a co-payment on their medications.

To get prescription medications you will need a prescription from your PCP or specialist. Many overthe-counter drugs may also be covered as long as you have a prescription. Please call UI Health Plus Member Services at 1.844.810.2273 if you need help finding a pharmacy or if you have any other questions.

Dental Services You DO NOT NEED A REFERRAL from your PCP for dental services. Medicaid covers dental services for children and adults. These services include visits to prevent disease, detect problems and restore your teeth – such as exams, teeth cleaning, cavity filling, root canals, and extractions. In some cases, there may be a co-pay for services, but there are no copays for exams. There may also be limitations on how often you can get a service.

Under the dental benefit, we encourage you to go to a dentist for an oral exam. At the exam, your dentist will develop a treatment plan for you. If the treatment plan includes a covered dental service that requires prior approval, the dentist will request the approval.

If approved, the dentist can perform the service.

If you have any questions about finding a dentist or what is covered under your dental benefit, call UI Health Plus Member Services at 1.844.810.2273 or DentaQuest of Illinois at 1.888.286.2447. If you use a TTY, call 1.800.466.7566.

Vision Services

Transportation

You DO NOT NEED A REFERRAL from your Primary Care Provider (PCP) for Medicaid covered vision services.

You DO NOT NEED A REFERRAL from your PCP for

Medicaid covered vision services include eye exams, eyeglasses, and specialty services if needed. Adults are limited to one pair of eye-glasses in a two year period. Children are covered for eyeglasses as needed.

Vision services must be provided by a Medicaidenrolled vision care provider. There may be co-pays for a vision exam and other services. Check with your vision care provider. Some vision services and materials, such as contact lenses and low vision devices, require prior approval before you can get them. Your vision care provider will request prior approval if necessary.

Eye Specialists and Services An eye specialist is called an ophthalmologist or optometrists. To see an ophthalmologist or optometrist because of eye disease or eye injury, you DO need a referral from your PCP. To find out what vision services are covered for you, call UI Health Plus Member Services at 1.844.810.2273 or the HFS Health Benefits Hotline at 1.866.468.7543 (TTY 1.877.204.1012). The call is free.

non-emergency transportation services. If it is hard for you to get to your medical appointments either because you do not have a car to use or because you cannot afford the gas, Medicaid may be able to help you get a ride to your PCP or clinic. This is not for ambulance services. HFS covers non-emergency transportation to the nearest possible provider only.

To see if you qualify for non-emergency transportation services, call First Transit at 1.877.725.0569. If you use a TTY, call 1.877.204.1012. You can call between 8:00 a.m. and 5:00 p.m. Monday through Friday. The call is free. You must call and ask for help to get a ride at least two business days (not counting weekends or holidays) before the trip.

When you call for approval for a ride, you must give: • The name, address, and phone number of the person who needs the ride • The recipient identification number (this is the number on the person’s UI Health Plus ID card) • The name and address of the provider or clinic the person will be seeing • The date, time, and reason for the appointment • The name of the transportation provider, if known If you need help finding a transportation provider, First Transit can help.

If you need help finding a vision care provider, ophthalmologist, or optometrist, please call UI Health Plus Member Services at 1.844.810.2273 or Illinois Health Connect at 1.877.912.1999 (TTY: 1.866.565.8577)

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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Preventive Services and Health Education UI Health Plus wants to keep you and your children healthy. You may get your children’s immunizations, medical checkups, and care through UI Health Plus.

Care Coordination and Disease Management We want to help you manage your chronic disease.

Do you have asthma, diabetes, or another type of chronic disease? Then you may benefit from care management.

UI Health Plus helps you take care of your health.

Depending on your need for health management, you can get one-on-one help from a personal care coordinator. The care coordinator will teach you how to control your disease. You will learn how to eat, exercise and take your medicine. Care coordination gives you the education you need to be healthy.

Women’s Health (if you become pregnant) If you think you are pregnant,call your PCP as soon as possible. See your provider early in your pregnancy. We want you to have a healthy baby.

When you are pregnant, see your provider at least: • Every 4 weeks during the first 6 months.

• Every 2 weeks during the 7th and 8th months.

• Every week during the last month.

Eat healthy food. Do NOT smoke when you are pregnant. Do NOT drink alcohol while you are pregnant. Do NOT use any medicine or drugs unless you ask your PCP. If you need assistance with food for you or your baby, go to a WIC (Women Infant & Children) Center. UI Health has a WIC Center at the Mile Square Health Center, located at 1220 South Wood Street.

To contact UI Health’s WIC Center call 1.312.413.8819 or for a list of WIC sites near you, call the Public Health Hotline at 1.800.545.2200. If you need other special help, call Member Services at 1.844.810.2273.

We will try to help you.

Well-Baby Care Babies need to see a provider several times in their first year—even if they are not sick.

At well-baby visits your child’s provider will: • Give shots that protect your baby from serious illnesses.

• Make sure your baby is growing properly.

• Identify problems that may require special care.

• Guide you in feeding and helping your baby fall asleep.

• Answer any questions you have about your baby.

The first well-baby visit is in the hospital at the time of birth. The second well-baby visit is during the first 2 weeks of life. After that, you should take your baby to his or her care provider for check-ups and shots as recommended by your provider.

If you have received a client enrollment packet for your baby, you can choose the same plan for your baby that you are in, or you may choose a different health care plan for your baby. To learn more about your health plan options, contact Client Enrollment Services at 1.877.912.8880 or TTY: 1.866.565.8576.

Or visit www.enrollhfs.illinois.gov.

Once you have established your baby’s provider, set up appointments for your baby’s well-baby visits at ages:

1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months

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Immunizations for Babies These are the vaccinations your baby needs: At Birth

HepB

2 Months

HepB (1-2 months) + DTaP + PCV + Hib + Polio + Rv

4 Months

HepB2 + DTaP + PCV + Hib + Polio + Rv

6 Months

HepB (6-18 mos1) + DTaP + PCV + Hib3 + Polio (6-18 mos1) + Rv + Influenza (6-59 mos1,4)

12 Months or older

MMR + DTaP + PCV + Hib + Chickenpox + HepA + Influenza (12-15 mos1) (15-18 mos1,5) (12-15 mos1) (12-15 mos1) (12-15 mos1) (12-23 mos1) (6-59 months 1,4)

Check with your child’s provider or nurse to make sure your baby is receiving all vaccinations on schedule. Many times vaccines are combined to reduce the number of injections. Be sure you ask for a record card with the dates of your baby’s vaccinations; bring this with you to every visit.

Here’s a list of the diseases your baby will be protected against: • HepB: hepatitis B, a serious liver disease • DTaP: diphtheria, tetanus (lockjaw), and pertussis (whooping cough) • PCV: pneumococcal conjugate vaccine, protects against a serious blood, lung and brain infection • Hib: Haemophilus influenza type b, a serious brain, throat and blood infection • Polio: a serious paralyzing disease • Rv: rotavirus infection, a serious diarrheal disease • Influenza: a serious lung infection • MMR: measles, mumps and rubella • HepA: hepatitis A, a serious liver disease • Chickenpox: also called varicella Footnotes to above Chart: 1. This vaccine should be given in this age range.

2. Your infant may not need a dose of Hep B vaccine at age 4 months depending on the type of vaccine that your health care provider uses.

3. Your infant may not need a dose of Hib vaccine at age 6 months depending on the type of vaccine that your health care provider uses.

4. Everyone should receive vaccination for influenza in the fall of each year. First-time flu vaccines should receive two doses, separated by at least 4 weeks.

5. This dose of DTaP may be given as early as 12 months if it has been 6 months since the previous dose and if you think you might not return for more shots by the time your child is age 18 months.

Further information about immunizations can be found at CDC.gov and ACIP.org.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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MEMBER RIGHTS UI Health Plus members will be informed of their rights and responsibilities every year. You are free to apply your rights without any action taken against you.

You have the right to: • Be treated with respect, dignity, and privacy.

• Have your PCP and other people treating you explain your treatment in a way that makes sense to you.

• Ask questions and have them answered by your PCP and other people treating you • Make decisions about the care you get. This includes saying “no” to care you don’t want.

• Get a copy of your medical records and have the records corrected if needed • Change your PCP as often as once a month.

• Pick the same PCP for you and your family, or pick different PCPs for each member of your family.

• Call your PCP and get help.

• Complain about your PCP or other UI Health staff or providers.

• Be free from any means of discrimination or retaliation.

MEMBER RESPONSIBILITIES You have the responsibility to:

• Share important information that is needed by your providers.

• Follow the instructions and guidelines given by your PCP and other people treating you.

DISENROLLMENT PROCEDURES You have 90 days from enrollment to disenroll from UI Health Plus and change plans. After that, you will have an opportunity to change plans once a year during your annual open enrollment period.

To learn more about your health plan options, call Client Enrollment Services at 1.877.912.8880 or TTY: 1.866.565.8576. Or visit www.enrollhfs.illinois.gov.

If you have been disenrolled from UI Health Plus and don’t know why, call Client Enrollment Services at 1.877.912.8880 or TTY: 1.866.565.8576 to speak to a customer service representative.

ADVANCE DIRECTIVES (LIVING WILL) This is a way to tell your primary care provider (PCP) and family how you want to be taken care of if you cannot speak for yourself. It is a legal paper that states what medical care you want. If you have questions, talk to your PCP.

• Learn your rights as a UI Health Plus member.

• Keep your appointments and cancel in advance the ones you cannot keep.

GRIEVANCE PROCEDURE

• Treat your PCP and other UI Health staff with respect.

If you have a problem or complaint, UI Health Plus wants you to get the best possible medical care and service. When something goes wrong or you are not treated well, we want to know.

• Tell your PCP and other people treating you about your healthcare needs and about any other healthcare services you are getting.

• Keep up-to-date on immunizations (shots).

• Contact your PCP first for care that is not an emergency.

• Get a referral from your PCP before getting care that needs a referral.

• Tell your PCP about other services you get that do not need a referral.

• Let UI Health Plus know about important changes, such as changes in your name, address, phone number, income, family size, or health.

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What is a Grievance?

A grievance is a complaint to UI Health Plus about any matter involving UI Health Plus other than a denied, reduced or terminated service or medical item.

UI Health Plus takes member grievances very seriously. We want to know what is wrong so we can help you and make our services better. UI Health Plus has special procedures in place to help members who file grievances. We will do our best to answer your questions or help to resolve your problem or concern.

Filing a grievance will not affect your health care services or your benefits coverage.

These are examples of when you might want to file a grievance with UI Health Plus: • Your medical provider or a UI Health Plus staff member did not respect your rights.

You can designate another person to help you file a grievance with us. You will need to fill out the Authorized Representative Designation form.

• You had trouble getting an appointment with your provider or Care Coordinator, or talking with your provider or Care Coordinator, in an appropriate amount of time.

This form is on the UI Health Plus website, www.UIHealthPlus.org. You can also obtain this form by calling UI Health Plus Member Services at 1.844.810.2273 - Toll Free; or 1.844.910.2237 - Voice/ TTY.

• You were unhappy with the quality of care or treatment you received.

STEP 2: REVIEWING YOUR GRIEVANCE

• Your provider or a UI Health Plus staff member was insensitive to your cultural needs or other special needs you may have.

STEP 1: HOW TO FILE A GRIEVANCE. If you have a grievance about your Primary Care Provider, UI Health Plus, or the service you have received: You can call UI Health Plus Member Services at 1.844.810.2273 - Toll Free; or 1.844.910.2237 - Voice/TTY to report it.

You can put your grievance in writing and mail to: UI Health Plus Attn: Grievance Dept.

1240 E. Diehl Road, Suite 100 Naperville, IL 60563 You can email your grievance to UIHealthPlus@uic.edu.

We will make a record of your grievance. We will have someone not involved with the matter you are complaining about review your grievance and try to find a solution. Your satisfaction is important to us.

STEP 3: TAKING ACTION ON YOUR GRIEVANCE We take action on all grievances within 30 days of receiving it. We will let you know what we decide.

STEP 4: IF YOU ARE NOT SATISFIED WITH THE ACTION WE TAKE ON YOUR GRIEVANCE, YOU MAY MAKE AN APPEAL AND SEND TO: Illinois Department of Healthcare and Family Services Bureau of Managed Care Attn: ACE Grievances 401 South Clinton Street, 6th Floor Chicago, IL 60607 Someone from HFS will review the matter and follow up with you as quickly as possible.

Or you can file your grievance online at www.uihealthplus.org

When you file your grievance, give us as much information as you can. For example, include the date and place the incident happened, the names of the people involved, and details about what happened.

Be sure to include your name and your UI Health Plus member ID number.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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APPEALS

How to Make an Appeal

You may not agree with a decision or an action made by the Illinois Department of Healthcare and Family Services (HFS) or the Illinois Department of Human Services (DHS). An appeal is a way for you to ask for a review of the Department’s (HFS or DHS) actions and decisions. For example, you may not agree with a decision made or an action by the Department about your services or a medical item you requested.

When you file your appeal, tell the Department what action or decision you disagree with and want them to review. Be sure to include your name, address, phone number, email, and your HFS Medical Card Identification Number (the “ID#” next to your name on the Medical Card).

You may appeal within sixty (60) calendar days of the date on the letter from the Department informing you of its denial or action. If you want your services to stay the same while you appeal, you must file your appeal no later than ten (10) calendar days from the date on the Department’s letter informing you of its denial or action. You can designate another person to help you file an appeal with us. We will need something in writing that authorizes that person to speak on your behalf. When you appeal, you are asking for a hearing to review the Department’s action or decision that you disagree with. The person reviewing the Department’s action or decision will be a hearing officer.

The list below includes examples of when you might want to file an appeal. You may want to appeal if the Department: • Does not approve or pay for a service or item that you or your provider asks for • Stops your benefits (coverage) • Says that you will start to get fewer benefits • Changes your co-payments You can also appeal if you think the Department made a mistake about any action or decision.

You may not get a hearing on your appeal if the Department’s action or decision was because of a change in the law.

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An appeal is filed either with HFS or DHS, depending on the agency that made the decision you are contesting. Generally, appeal is filed with the agency that made the decision and sent you the letter informing you of its denial or action.

If you want to file an appeal related to your medical services or items, Developmental Disability (DD), or Elderly Waiver (Community Care Program (CCP)) services, send your request in writing via mail, fax, or email to: Illinois Department of Healthcare and Family Services Attn: Fair Hearings Section 401 South Clinton, 6th Floor Chicago, IL 60607 Fax #: 312.793.2005 Email: HFS.FairHearings@illinois.gov Or you may call HFS at 1.855.418.4421. If you use a TTY, call HFS at 1.877.734.7429. The call is free.

If you want to file an appeal related to your Medicaid application eligibility, food stamps, TANF, Persons with Disabilities Waiver services, Traumatic Brain Injury Waiver services, HIV/AIDS Waiver services, or any Home Service Program (HSP) services, send your request in writing via mail, fax, or email to: Illinois Department of Human Services Attn: Bureau of Hearings 401 South Clinton, 6th Floor Chicago, IL 60607 Fax #: 312.793.3387 Email: DHS.BAHNewAppeal@illinois.gov

Or you may call DHS at 1.800.435.0774. If you use a TTY, call DHS at 1.877.734.7429. The call is free.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

UI HEALTH PLUS PRIVACY NOTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices (“Notice”) describes the privacy practices of UI Health Plus. It applies to the health care services you receive as a UI Health Plus Member, including its employees, contracted physicians, nurses, staff and volunteers.

UI Health Plus provides care in an academic environment; therefore, residents, medical students, nursing students and students of other health professions may also use or disclose your protected health information. In this Notice, UI Health Plus and all of its departments, units, health care providers, staff, volunteers, residents, students and trainees are collectively referred to in this Notice as “we” or “us.”

We are required by law to give you this Notice of our privacy practices, legal responsibilities and your rights. We are required to follow the terms of this Notice or other notice in effect at the time we use or disclose your health information. This Notice also describes (i) the types of uses and disclosures we may make with your health information; and (ii) your rights to access and control your health. There are other laws that provide additional protections for certain medical information related to services or treatment for certain conditions including genetic testing, mental health, alcohol abuse, drug abuse, and HIV/AIDS. We will follow the requirements of those laws with respect to these types of medical information.

WE MAY USE AND DISCLOSE INFORMATION FOR THE FOLLOWING PURPOSES Treatment: We may use or disclose your health information to provide treatment, and to coordinate or manage your health care and any related services. For example, we give information to providers, nurses, lab technicians, students, and others, including information from tests you receive and we record that information for others to use. We may give information to other providers outside of UI Health Plus to arrange for a referral or consultation.

Payment: We may use or disclose your health information, as needed, to release payment for your health care services. For example, we may contact your provider to confirm benefits for which you are eligible, provide prior authorization, and give them details they need about your treatment. We may also use or disclose your medical information to get payment from third parties that may be responsible for payment, such as family members.

Healthcare Operations: We may use or disclose your health information, as needed, in order to perform health care operations. Health care operations include, but are not limited to: training and education, quality assessment/improvement activities, risk management, claims management, legal consultation, physician and employee review activities; licensing; regulatory surveys; and other business planning activities.

Business Associates: We may also disclose your health information to our third-party business associates (for example, an accounting firm or billing company) that perform activities or services on our behalf. Each business associate must agree in writing to protect the confidentiality of your information.

Marketing Activities: We may use or share your health information to discuss products or services with you face to face or to provide you with an inexpensive promotional gift related to a product or service. For any other types of marketing activities, including sending you marketing materials, (excluding direct mail sent to targeted zip codes that are not based off patient lists) we must get your written permission before using or disclosing your health information.

Appointments and Services: We may use and disclose your health information to remind you of an appointment or to give you information about treatment alternatives or other health related benefits or services that may interest you.

Individuals Involved In Your Care: We may disclose your health information to a friend or family member who is involved in your care unless you ask us not to.

Disaster Relief Organizations: We may disclose information to disaster relief organizations, such as the Red Cross, so your family can be notified about your condition and location.

OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR AUTHORIZATION, CONSENT OR OPPORTUNITY TO OBJECT Required By Law: We may use or disclose your health information to the extent that the use or disclosure is required by federal, state or local law, but only to the extent and under the circumstances provided in such law.

Legal Proceedings: We may disclose your health information in response to court or administrative orders, or under certain circumstances in response to subpoenas, discovery requests or other lawful processes.

Law Enforcement: We may disclose your health information to law enforcement in certain circumstances, i.e., to identify or locate suspects, fugitives, witnesses or victims of crime, to report deaths from crime, to report crimes on the premises or, in emergencies, the commission of a crime.

National Security: We may disclose your health information to authorized federal officials for conducting national security and intelligence activities including for the provision of protective services to the President.

Criminal Activity: We may disclose your health information consistent with applicable federal and state laws if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Public Health: We may use or disclose your health information for public health activities such as reporting births, deaths, communicable diseases, injury or disability, ensuring the safety of drugs and medical devices, and for work place surveillance or work related illness and injury.

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Communicable Diseases: We may disclose your health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of getting or spreading the disease or condition.

Worker’s Compensation: We may disclose your health information as authorized to comply with worker’s compensation laws and other similar legally established programs.

Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law such as audits, administrative or criminal investigations, inspections, licensure or disciplinary action and monitoring compliance with the law.

Any other uses and disclosures of your health information not described in this Notice will be made only with your permission.

Examples of uses and disclosures which require your written authorization include: (i) most uses and disclosures of psychotherapy notices (private notes of a mental health professional kept separately from the record); (ii) subject to limited exceptions (described above), uses and disclosures of your health information for marketing purposes; and (iii) disclosures that constitute the sale of your health information.

You may revoke your authorization at any time, in writing, but only as to future uses or disclosures, and only where we have not already acted in reliance on your authorization.

Abuse, Neglect or Domestic Violence: We may disclose your health information to a public health authority that is authorized by law to receive reports of abuse or neglect, including reporting child and sexual abuse. In addition, we may disclose your health information if we believe you may be a victim of abuse, neglect or domestic violence, to the governmental agency or entity authorized to receive such information. This disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration (FDA): We may disclose your health information to a person or company required by the FDA to report adverse events, product defects or problems, biologic product deviations or to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Coroners, Medical Examiners and Funeral Directors: We may disclose your health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose your protected health information to a funeral director in order to permit them to carry out their legal duties.

Organ Donation: We may disclose your health information to organizations that handle organ procurement and/or eye or tissue transplantation.

Research: We may disclose your health information to researchers when our institutional review board has approved their research. Our board reviews research proposals and established protocols to ensure your privacy. If you participate in a research study that requires you to obtain University of Illinois Hospital & Health Sciences System (UI Health) and/or other health care services, we may disclose your information that we create to the researcher who ordered the UI Health or health care services. We may also use and disclose with a researcher your information if certain parts of your information that would identify you, such as your name, are removed before we share it.

Military Activity: We may disclose your health information if you are in the armed forces and information is required by command authorities or for the purposes of a determination by the Department of Veteran Affairs of your eligibility for benefits.

Correctional Institutions: We may disclose your health information if you are an inmate, for your health and the health, and safety of others.

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YOUR HEALTH INFORMATION RIGHTS Right to Obtain a Copy of this Notice of Privacy Practices You have the right to get a paper copy of the Notice currently in effect upon request. You have the right to get a paper copy of this Notice upon request, even if you have agreed to accept this notice electronically.

Right to Request a Restriction on Certain Uses and Disclosures You have the right to request restrictions on uses and disclosures of your medical information for the purposes of treatment, payment or health care operations. We ask that such requests be made in writing. Although we will consider your request, we are not required to abide by your request except in the following situation: If you have paid an item or service out-of- pocket in full, at your request, we will not disclose information relating solely to that item or service to your health plan for purposes of payment or health care operations, unless we are required by law to make the disclosure. It is your responsibility to notify any other providers about such a request. Please contact our Privacy Office if you have any questions about requesting restrictions on the uses and disclosures of your medical information.

Right to Inspect and Request a Copy of Your Health Record You have the right to look at and get a copy of your health record, except in a few situations defined by federal and state laws and regulations. You may request that we send copies of your health record to another person identified by you. A reasonable fee may be charged to copy and/or send your record, as permitted by law. If your record is kept electronically, we will provide you with a copy of the record in a readable electronic form and format. If you are denied access to your health record for certain reasons, the denial may be reviewable.

Please contact our Privacy Officer at the telephone number or address below for more information or to request access to copies of your records.

Right to Request an Amendment to Your Health Record You may make a written request to change your protected health information, as long as the information is kept by or for us. You must give us a reason for the amendment (change). In certain cases, we may deny your request for an amendment.

If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement. We will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have any questions about changing your health record.

Right to Obtain a Record of Disclosures of Your Health Information You have the right to request a record of some of the disclosures of your health information made by us. The first record will be provided to you free, but you may be charged for any additional requests during the same calendar year.

Please contact our Privacy Officer to obtain an Accounting and Disclosure Report.

Right to Request Communication of Your Health Information You have the right to request that confidential communications be made by different means (e.g. fax versus mail) or at different locations (alternate address or telephone number). Your request must be in writing. We will honor your request if it is reasonable.

UI HEALTH PLUS MANAGEMENT POLICY AND PROCEDURE Contact for Requests or Questions About this Notice To exercise any of the rights described above, or if you have any questions about this Notice, please contact 1.844.810.2273 or by mail at: UI Health Plus 1240 E. Diehl Road, Suite 100 Naperville, IL 60563 1.844.810.2273; 1.312.738.3116 (This is not a location for medical care, this is for mail only.)

UI Health Plus May Contact You UI Health may contact you for reminders about routine services, appointments, and general information about keeping you healthy.

To Change Personal Information To change personal information such as your address, please call member services at 1.844.810.2273. Also be sure to change your information with the Post Office and the state by calling the DHS Helpline at 1-800-843-6154.

Complaints Right to Receive Notice of a Breach You have the right to be notified in writing following a breach of your health information that was not secured in accordance with security standards as required by law.

If you believe that we have violated your privacy rights, you may file a complaint with us by contacting 1.844.810.2273 or by mail to: UI Health Plus 1240 E. Diehl Road, Suite 100 Naperville, IL 60563 1.844.810.2273; 1.312.738.3116 (This is not a location for medical care, this is for mail only.)

You also have the right to file a written complaint with the Secretary of the Department of Health and Human Services, Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue. S.W., Room 509F, HHH Building, Washington, D.C. 20201. You will not be penalized for filing a complaint.

Changes to this Notice We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our web site at www.UIHealthPlus.org.

Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org

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Questions? Contact UI Health Plus Member Services: 1.844.810.2273 TTY for the Hearing Impaired: 1.844.910.2273 Website: www.UIHealthPlus.org