Partnership HealthPlan of California

Medi-Cal Member Handbook

Together for your Health

Our Service Area (Counties)

Other languages and formats Other languages You can get this Member Handbook and other plan materials for free in other languages. Call (800) 863-4155 (TTY: (800) 735-2929 or 711). The call is free. Other formats You can get this information for free in other formats, such as Braille, large print and audio. Call (800) 863-4155 (TTY: (800) 735-2929 or 711). The call is free. Interpreter services For information on free interpreter, language and cultural services there is help available 24 hours a day, 7 days a week, or to get this handbook in a different language, call (800) 863-4155 (TTY: (800) 735-2929 or 711). The call is free.

Language Assistance English ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call (800) 863-4155 (TTY: (800) 735-2929 or 711). Espaol (Spanish) ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Llame al (800) 863-4155 (TTY: (800) 735-2929 or 711). (Russian) : , . (800) 863-4155 (TTY: (800) 735-2929 or 711). Ting Vit (Vietnamese) CH : Nu bn ni Ting Vit, c cc dch v h tr ngn ng min ph dnh cho bn. Gi s (800) 863-4155 (TTY: (800) 735-2929 or 711). Tagalog (Tagalog Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (800) 863-4155 (TTY: (800) 735-2929 or 711). (Korean)

: ,

. (800) 863-4155 (TTY: (800) 735-2929 or 711)

. (Chinese) (800) 863-4155 (TTY: (800) 735-2929 or 711).

(Armenian) , : (800) 863-4155 (TTY () (800) 735-2929 or 711): (Farsi)

: . (TTY: (800) 735-2929 or 711) 4155-863 (800) .

(Japanese)

(800) 863-4155 (TTY: (800) 735-2929 or 711) Hmoob (Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (800) 863-4155 (TTY: (800) 735-2929 or 711). (Punjabi)

: ,

(800) 863-4155 (TTY: (800) 735-2929 or 711) ' (Arabic)

(800): . ).or (800) 735-2929 711( : 863-4155

(Hindi) : (800) 863-4155 (TTY: (800) 735-2929 or 711) (Thai) : (800) 863-4155 (TTY: (800) 735-2929 or 711).

(Cambodian) , (800) 863-4155 (TTY: (800) 735-2929 or 711) (Laotian) : , , , . (800) 863-4155 (TTY: (800) 735-2929 or 711).

Nondiscrimination Notice Discrimination is against the law. Partnership HealthPlan of California follows Federal civil rights laws. Partnership HealthPlan of California does not discriminate, exclude people, or treat them differently because of race, color, national origin, age, disability, or sex. Partnership HealthPlan of California provides:

Free aids and services to people with disabilities to help them communicate better, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic

formats, other formats) Free language services to people whose primary language is not English, such as:

Qualified interpreters Information written in other languages

If you need these services, contact Partnership HealthPlan of California between 8 a.m. 5 p.m. by calling (800) 863-4155. Or, if you cannot hear or speak well, please call (800) 735-2929 or 711. HOW TO FILE A GRIEVANCE If you believe that Partnership HealthPlan of California has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with Partnership HealthPlan of California. You can file a grievance by phone, in writing, in person, or electronically:

By phone: Contact Partnership HealthPlan of California between 8 a.m. 5 p.m. by calling (800) 863-4155. Or, if you cannot hear or speak well, please call (800) 735-2929 or 711.

In writing: Fill out a complaint form or write a letter and send it to:

In person: Visit your doctors office or Partnership HealthPlan of California and say you want to file a grievance.

Electronically: Visit website Partnership HealthPlan of California at www.partnershiphp.org

Partnership HealthPlan of California ATTN: Grievance 3688 Avtech Parkway Redding, CA 96002

Partnership HealthPlan of California ATTN: Grievance 4665 Business Center Drive Fairfield, CA 94534

Or

http://www.partnershiphp.org/

OFFICE OF CIVIL RIGHTS

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by phone, in writing, or electronically:

By phone: Call (800) 368-1019. If you cannot speak or hear well, please call TTY/TDD (800) 537-7697.

In writing: Fill out a complaint form or send a letter to: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Electronically: Visit the Office for Civil Rights Complaint Portal at

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.

http://www.hhs.gov/ocr/office/file/index.htmlhttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Dear Member,

Welcome!

You are now a member of the Partnership HealthPlan of California (PHC). PHC is a health plan for people who have Medi-Cal.

As a new PHC member there are some things you need to do.

Choose a Primary Care Provider (PCP) from the list of providers you received from PHC. This list of health care providers is called a Provider Directory.

Tell the PHC Member Services which PCP that you chose.

Please call your PCP as soon as possible to schedule an appointment for a health exam. You should have this health exam within 120 days from the date you became eligible for Medi-Cal. Your PCP will review your current medical and preventive health care needs. Health exam are a great way for you to know that you are in good health. Health exam are also a good way for your PCP to prevent health problems. The name and phone number of your assigned PCP is printed on your PHC ID card.

Please read this Handbook carefully. It will answer many questions about PHC. If you have any questions call PHCs Member Services at (800) 863-4155. We are available to help you Monday Friday, 8 a.m. 5 p.m. Hearing and/or speech impaired members can call the California Relay Service at (800) 735-2929 or call 711. Dont forget to visit our website at www.partnershiphp.org. Let's work together for your health! Sincerely, Partnership HealthPlan of California

http://www.partnershiphp.org/

Table of Contents

Section A - Important Phone Numbers ........................................................................................... 1

Section B - Member Rights and Responsibilities ........................................................................... 2

Section 1 Welcome to PHC! ........................................................................................................ 5

A quick look at what you need to know as a new PHC member.

Section 2 How to Enroll in Medi-Cal .......................................................................................... 8

What to know when you first become a member.

Section 3 Who gives me health care? ........................................................................................ 10

Learn about different kinds of providers and our network.

Section 4 How do I get primary (routine) care? ........................................................................ 13

Learn about choosing a PCP and getting primary care.

Section 5 How do I get specialty care? ...................................................................................... 17

Learn about Prior Approval and types of specialty care.

Section 6 Outpatient Mental Health Care .................................................................................. 20

Learn about getting mental health care from our network.

Section 7 Urgent and Emergency Care ...................................................................................... 21

Learn about how and where to get urgent and emergency care.

Section 8 Transportation ............................................................................................................ 24

Learn about different types of transportation services.

Section 9 Covered Services ....................................................................................................... 27

A list of benefits covered by PHC, State Medi-Cal or Other Programs.

Section 10 What does Medi-Cal not cover? .............................................................................. 42

Learn about what is not covered by PHC or Medi-Cal.

Section 11 Prescription Drugs ................................................................................................... 43

Learn about our prescription drug benefit and how to get covered drugs.

Section 12 How to file a grievance ............................................................................................ 47

Learn about your grievance rights.

Section 13 Coordination of Benefits and Other Information ..................................................... 51

Learn about estate recovery, coordination of benefits.

Section 14 Your Privacy Rights ..........