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Subscriber Information

Upon enrollment members receive a Member Guide or an Evidence of Coverage (EOC) that includes:

  • Benefits and services included in, and excluded from, coverage
  • Pharmaceutical management procedures, if they exist
  • Copayments and other charges for which the member is responsible
  • Restrictions on benefits that apply to services obtained outside the organization's system or service area
  • How to obtain language assistance
  • How to submit a claim for covered services, if applicable
  • How to obtain information about practitioners who participate in the organization
  • How to obtain primary care services, including points of access
  • How to obtain specialty care and behavioral health services and hospital services
  • How to obtain care after normal office hours
  • How to obtain emergency care, including the organization's policy on when to directly access emergency care or use 911 services
  • How to obtain care and coverage when members are out of the organization's service area
  • How to voice a complaint
  • How to appeal a decision that adversely affects coverage, benefits or their relationship with the organization
  • How the organization evaluates new technology for inclusion as a covered benefit

If you need further assistance you may call the Customer Service Department.