At IEHP, we believe in rewarding our Team Members for their talent and contribution to our mission. Every child deserves a stable, safe, and supportive family. Summary of Benefits and Coverage (SBC) Templates, Instructions, and Related Materials - for plan years beginning on or after 4/1/17. 1457 0 obj <>stream for details. It provides health, dental and vision* coverage to qualified low-income California residents. rQ&RqL_F{M' s+ )L@!|5fJ%"82O$6F*) 3Z ~ Y#. Learn more about resources in languages other than English. We also have services to protect adults from abuse and neglect. L.A. Care Covered Gold 80 HMO Evidence of . Before sharing sensitive information, make sure youre on a federal government site. Additionally, you can freely decide and change any time whether you accept cookies or choose to opt out of cookies to improve website's performance, as well as cookies used to display content tailored to your interests. Your Part B premium may differ based on factors including late enrollment, income, and disability status. %PDF-1.6 % You may request a printed copy of the Member Handbook by calling our Member Services department at 1-855-270-2327 (TTY 711 ). Medi-Cal Plan No-cost or low-cost health care coverage for low-income adults, families with children, seniors, and people with disabilities. Consider or children in need. This includes cookies necessary for the website's operation. IEHP DualChoice (HMO D-SNP) .table thead th {background-color:#f1f1f1;color:#222;} B%32/`N`da 1}v 500mZT` pau{@Z!o~Z@ bM is offered in the following locations. =========== 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. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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. This is only a summary. TTY users should call 1-800-430-7077. Washington, DC 202101-866-4-USA-DOL, Employee Benefits Security Administration, Mental Health and Substance Use Disorder Benefits, Children's Health Insurance Program Reauthorization Act (CHIPRA), Special Financial Assistance - Multiemployer Plans, Delinquent Filer Voluntary Compliance Program (DFVCP), State All Payer Claims Databases Advisory Committee (SAPCDAC), Summary of Benefits and Coverage and Uniform Glossary, Notice Agency Information Collection Activities, Solicitation of comments Templates, Instructions, and Related Materials, Culturally and Linguistically Appropriate Services (CLAS) County Data, Summary of Benefits and Coverage (SBC) Template, Instructions for Completing the SBC - Group Health Plan Coverage, Instructions for Completing the SBC - Individual Health Insurance Coverage, Why This Matters language for "Yes" Answers, Why This Matters language for "No" Answers, HHS Information For Simulating Coverage Examples, HHS Coverage Example Calculator and Related Information, List of anchors for SBC Uniform Glossary terms, Uniform Glossary of Coverage and Medical Terms, SBC and Uniform Glossary Translations - Chinese, Spanish, Tagalog, and Navajo, Instructions for Completing the SBC Group Health Plan Coverage, Instructions for Completing the SBC Individual Health Insurance Coverage. The SBC shows you how you and the plan would share the cost for covered health care services. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. You can become the loving parent a child needs and deserves. This is meant to help you compare your options and understand your coverage. Your experience of the site and the services we are able to offer may be impacted if you do not accept all cookies. All Rights Reserved. It details the coverage and costs for any Affordable Care Act-compliant health plan. Click to Call 1-877-354-4611 TTY 711. 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! We believe in helping YOU take care of yourself and your family. Youll find a link to the SBC on each plan page when you preview plans and prices before logging in, and when you've finished your application and are comparing plans. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. #block-googletagmanagerheader .field { padding-bottom:0 !important; } IEHP DualChoice (HMO D-SNP) KtV We believe in the power of partnerships. IEHP DualChoice (HMO D-SNP) IEHP DualChoice (HMO D-SNP) .agency-blurb-container .agency_blurb.background--light { padding: 0; } ]]>*/, An agency within the U.S. Department of Labor, 200 Constitution AveNW would share the cost for covered health care services. This is only a . IEHP DualChoice (HMO D-SNP) Evidence of Coverage. If you or your has limited income, Medi-Cal provides health coverage for no or low-cost. You have the right to an easy-to-understand summary about a health plans benefits and coverage. /*--> >Ivg@K, This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. All rights reserved | About | Contact | Legal and Privacy. We want to help. 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. H8894 001 0 available in Riverside and San Bernardino Counties. Get help from a licensed Medicare agent. The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). For those struggling with low income, we offer assistance programs for food, cash, housing and health coverage. We have several customer service locations across our 7,300 square-mile county where you can find help. endstream endobj startxref . Press Tab to Move to Skip to Content Link. %vM:+&Z$RI\\?wNuVS!n} .usa-footer .container {max-width:1440px!important;} ol{list-style-type: decimal;} This is only a summary. View Plan Details How to Get Care Health Insurance Marketplace is a registered trademark of the Department of Health and Human Services. k)fXgj&*mg{~?>4CI[s10|=C>G>%/K yN&0xk^8Z^q. ! x}koH?5,H=Ht.cX(lmKIM7:XHxhGRyj'}wz/n6}~ya~Z=r~~}o~*,)7X0)K2x""-UerS/L[eo~=Kf|?~Vf\+yEr f|3),-$B:. In addition to the benefits that come with your plan, you can choose to buy a supplemental benefit package called Advantage Plus. Previous Next ===== TABBED SINGLE CONTENT GENERAL. F|]u_>6|hWoU`z^b>ZMTvYMuzut/u!\z ,d$oS!*y(bS96DbX}IZ7o=e"0]-X]$`WRQ\LB6:P$CT/Y"~&! Our mission is to help our residents find a path to financial independence. Copy Page Link. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer. Here you can find access to Family Resource Centers and crisis prevention services. Learn more by clicking here. hb```f``Z pA2,Nh0b SBC document helps you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. 1 of 5 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 - 12/31/2023 Mr. Greens Cannabis: UFCW Local 3000 Coverage for: Individual + Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC . "::B (fPP5HK:~f6|\LrZ* PQoE_}a`@`C'= Summary of Benefits and Coverage (SBC) Template | MS Word Format. %PDF-1.7 ozI?TNt2J\2 k/=Ak You may be able to get the SBC and Uniform Glossary in a language other than English upon request. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Health care is crucial for you and your family. Share via Email. 3 0 obj 0 Please contactMedicare.govor1-800-MEDICARE to get information on all of your options. 1203 0 obj <>/Filter/FlateDecode/ID[<2EA2F92DEE203348B8E2055B85623233>]/Index[1175 44]/Info 1174 0 R/Length 127/Prev 402092/Root 1176 0 R/Size 1219/Type/XRef/W[1 3 1]>>stream We partner with agencies and organizations that share our mission to help and protect those most in need. Instructions for Completing the SBC - Group Health Plan Coverage and Consumer Assistance Programs. (866) 294-4347 A short, plain-language Summary of Benefits and Coverage (SBC), A Uniform Glossary of terms used in health coverage and medical care. We protect our communitys most vulnerable children and adults. 1800 0 obj <>stream Contact the plan for details. The SBC shows you how you and the plan would share the cost for covered health care services. hbbd``b` + b, DqA@BT$-P/c`% The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} We use cookies to offer you the best possible website experience. We have many resources at your disposal, such as financial assistance, housing assistance, and mental health support. d.Y&8&MUgQ We work with community partners and the courts to bring families together. (800) 718-4347 (TTY), IEHP 24-Hour Nurse Advice Line (for IEHP Members only) stream Medi-Cal is a no-cost or low-cost health coverage program. Competitive Salary and Benefits Package Essential Health Benefits Summary A one-page Essential Health Benefits Summary is available for download. .manual-search ul.usa-list li {max-width:100%;} Children with Medi-Cal coverage under the Childrens Health Insurance Program (CHIP) will have a low monthly premium. See how they can help you, your family, and your community! TTY users should call (800) 720-4347. 1218 0 obj <>stream 2023 Open Enrollment is over, but you may still be able to enroll in 2023 health insurance through a Special Enrollment Period. NOTE: Information about the cost of this plan (called the premium) will be provided separately. TAhh])f?u Vh7 IEHP - Medi-Cal California Medical Insurance Requirements : Welcome to Inland Empire Health Plan \. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. %PDF-1.5 % This is only a summary. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*). .paragraph--type--html-table .ts-cell-content {max-width: 100%;} We offer cash and housing assistance, such as access to hotel/motel vouchers. 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. Were here to help! (877) 273-4347 1 0 obj Sample Completed SBC | MS Word Format. Yes. %%EOF Please, see below for location details, contact numbers, and hours of operation. .usa-footer .grid-container {padding-left: 30px!important;} In this booklet, you will find an overview of our plan, an easy -to -read chart of plan coverage options, and contact . .cd-main-content p, blockquote {margin-bottom:1em;} If you need a paper copy, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical Program. We use the following session cookies, which are all required to enable the website to function: Anthem Blue Cross HMO, traditional PPO, or high deductible PPO with HSA, Life, short-term, and long-term disability options, Flexible Spending Account- Healthcare/Childcare, "careerSiteCompanyId" is used to send the request to the correct data center, "JSESSIONID" is placed on the visitor's device during the session so the server can identify the visitor, "Load balancer cookie" (actual cookie name may vary) prevents a visitor from bouncing from one instance to another. endobj Outpatient (Ambulatory) Services Physician services Hospital outpatient & outpatient clinic services Outpatient surgery (Includes anesthesiologist services.) <> Medicare has neither approved nor endorsed any information on this site. ~_5Id+(f c*pF03 cF3m-26Yc> !c YJya%XL 2 0 obj offers the following coverage and cost-sharing. .manual-search ul.usa-list li {max-width:100%;} endstream endobj startxref Please read the Evidence of Coverage for the full list of benefits. plan (called the premium) will be provided separately. We do not offer every plan available in your area. We only use data released publicly each year. Trust is built on communication. Your cookie preferences will be stored in your browsers local storage. Important Reading for IEHP Medi-Cal Members, IEHP Medi-Cal Member Services }Y+\(s1Qi}=Y1$C'oX` The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. These cookies are required to use this website and can't be turned off. endstream endobj startxref 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. With our. An official website of the United States government. #block-googletagmanagerfooter .field { padding-bottom:0 !important; } While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. All insurance agents and enrollment platforms linked to this site have their own terms and conditions. @media (max-width: 992px){.usa-js-mobile-nav--active, .usa-mobile_nav-active {overflow: auto!important;}} Want to speak to someone face-to-face? After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs. You may also call Health Care Options at 1-800-430-4263or visit www.healthcareoptions.dhcs.ca.gov. hYmOH+qn[Z!ff{]&1`ms~XvwWU=OU]GJ*bf**mB5Tp38h&d*C t%]3L0eb6R1,1y;H$H$RZ*SJi6ZMbRl*,vj-(YO9VY!swc>=;+4I1GkWWL W''5hJXzxqu*NNhO.i)?9YV,:.9?1S&eLi.7tz1A59gAG=\?IqK5+]YjtRG|4OG43TET~o7tA)4 ? 711 (TTY), To Enroll with IEHP When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. All plan-related information on this site is from CMS.gov and Medicare.gov. also provides the following benefits. Check if you qualify for a Special Enrollment Period. Ready to sign up for IEHP DualChoice (HMO D-SNP) 1175 0 obj <> endobj Medi-Cal Dental Coverage . Share via Facebook. <> The site is secure. Coverage for: Individual + Family | Plan Type: EPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. At IEHP, we believe in rewarding our Team Members for their talent and contribution to our mission. 2023 Inland Empire Health Plan All Rights Reserved. In fact, its our top priority. Medi-Cal (the name for Medicaid in California) offers comprehensive coverage, including mental health resources. (800) 440-4347 Applicability: Plans and issuers will be required to use the 2021 Summary of Benefits and Coverage (SBC), the 2021 SBC Calculator Guide and Narratives, and, should they choose to use the SBC Calculator, the 2021 SBC Calculator beginning on the first day of the first open enrollment period for any plan years (or, in the individual market, policy Enroll on the phone or online! is a Medicare Advantage (Part C) Special Needs Plan by IEHP DualChoice. -l IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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. This is why we at the Riverside County Department of Social Services offers a variety of ways for you to keep up to date with our programs and services! .manual-search-block #edit-actions--2 {order:2;} IEHP is among the largest Medicaid health plans and the largest non-profit Medicare-Medicaid plan in the country. Factsonmedicare.com is a free-to-use informational website. We do not directly sell health insurance or offer professional legal, medical, or financial advice. 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. The SBC shows you how you and the plan would share the cost for covered health care services. The SBC shows you how you and the plan. 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), $0 copay (limits may apply) (authorization not required) (referral not required). Share via LinkedIn. % You need a roof over your head. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} Welcome to Summary of Benefits and Coverage (SBC) document posting site for Medical and Dental documents. %H_iuaVU%]{Wr68~&=}\F7\&Ec\bY]0f"=_]1Y/;h\Mph\32$H#db:aSV7f. Live help. 340 0 obj <>/Filter/FlateDecode/ID[<7683F4A8D47BF441B51CA1406C79AE5A>]/Index[324 78]/Info 323 0 R/Length 83/Prev 576238/Root 325 0 R/Size 402/Type/XRef/W[1 2 1]>>stream The SBC also includes details, called coverage examples, which show you what the plan would cover in 2 common medical situations: diabetes care and childbirth. hb```f``: Ab@cj[_d9^7'g\gW-]i.jgW=`);,:L::;:X3:::::;$PEGv+1[X This is only a summary. The SBC shows you how you and the plan would share the cost for covered health care services. The call is free. We work to stabilize Riverside County families that are struggling by providing access to food, housing, cash, childcare, and more. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. The SBC shows you how you and the plan would share the cost for covered health care services. important to review plan coverage, costs, and benefits before you enroll. Please check the plans formulary for specific drugs covered. This package is designed to help you stay healthy, meet your financial and retirement goals, develop your career and continue your education all while achieving a healthy work/life balance. See the . If you or your family is at risk of experiencing homelessness or is homeless, click here to learn more. Look on the Extra Help letters you get, or contact the plan to find out your exact costs. We also have partners throughout Riverside County waiting to help you at any time. This is only a summary. (=eVXPjZ=klnA0` 9bI1TE!~ZScs3$! Learn more here. Contact a plan for a Summary of Benefits. Here youll find the DPSS newsletter, press releases, compelling videos, regular podcasts and contact information for media inquiries. hbbd```b`` "A$ri " %f=X$L0i&u@d{:d JQua/V7 25O,G RlJ E7j{ 324 0 obj <> endobj No matter the insurance provider, all SBCs outline the same basic information. Some of the services listed are covered only if IEHP or your IPA approves first. You may also call Health Care Options at 1-800-430-4263. 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. .h1 {font-family:'Merriweather';font-weight:700;} This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. It covers families with children, seniors, persons with disabilities, foster care children, pregnant women, and low-income people with specific diseases. IMPORTANT: This page has been updated with plan and premium data for the 2023. Learn more by clicking here. We care about the people we serve and last year we served one million people in Riverside County. Please click here to learn more about our departments various programs, what they can do for you, and how to contact us. NOTE: Information about the cost of this plan (called the premium) will be provided separately. ei;N. See the Part D Premium Reduction section below for more details. The Inland Empire Health Plan (IEHP) provides low-income and working-class individuals and families with access to health services through the Medi-Cal program. <>/Metadata 2580 0 R/ViewerPreferences 2581 0 R>> Other languages can be selected below. 4 0 obj Any information we provide is limited to those plans we do offer in your area. .0$ga0Q.K*x~Q\],.t1dIajsV(@^|A(d!nmYm:9?DdqZ ],"J),EUzJ~9'$}`:yH qHmBQ#WF?828_ Your family is your top priority. NOTE: Information about the cost of this plan (called the premium) will be provided separately. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Apply here and learn more about benefits. ah v$c`bd`Qb`_g "[y 401 0 obj <>stream Your HBA, usually located in your agency's personnel office, can also print you a copy . The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. w@!nRKb As our older population rapidly expands, so does our communitys need for trustworthy, kind in-home caregivers. NOTE: Information about the cost of this plan (called the premium) will be provided separately. You may also qualify for Extra Help on drug costs. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R] /MediaBox[ 0 0 792 615] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Contact the plan for details. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. This could be right for you. We are to help you too! %PDF-1.7 % [CDATA[/* >