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al care as early as possible improves the chances of a healthy pregnancy and childbirth.  Receiving postpartum care after childbirth is just as crucial for a woman to make sure she is healing properly and gets the help she needs to care for herself and her baby. IEHP has programs that offer support for our pregnant Members throughout their pregnancy and after.   Baby-N-Me App     This is a free app for IEHP Members who are pregnant or have a baby under 2 years old. On this app pregnant Members can get up-to-date information about their growing baby like ultrasound videos, get handy tools like a weight gain calculator, complete a survey that screens for postpartum depression, set appointment reminders, and much more!    Parents of a baby under 2 years old can get parenting tips and advice, age-adapted information about their baby’s growth, feeding patterns, and tools to track diaper changes, growth, and vaccines.  You can download this app for free through iTunes or Google Play Loving Support Loving Support is committed to helping mothers achieve their breastfeeding goals. The Helpline offers advice, referrals to mom support groups and support and encouragement to get breastfeeding off to a good start. International Board Certified Lactation Consultants (IBCLCs) also offer guidance, pumping strategies and tips for returning to work/school or are pumping for their premature babies.  Call Loving Support with any questions or concerns you may have throughout the first year and beyond.  You can contact the Loving Support 24/7 Helpline at 888-451-2499/951-358-7212. The staff speaks English and Spanish. Breaking Maternal Mental Health Stigma - One Mom at a Time   Immediately after childbirth, most women experience “baby blues,” which can include mood swings, crying spells, anxiety and difficulty sleeping – all very normal, but short-lived symptoms. However, postpartum depression is more severe and long-lasting, usually requiring treatment from a mental health professional. For millions of new moms, like Inland Empire Health Plan (IEHP) Member Gerti, motherhood – and all the challenges it brings – can be overwhelming. After the birth of her daughter, Gerti struggled with her mental health and recognized she needed help.  Thankfully, she knew exactly where to turn.    Additional Resources The ABC's of Safe Sleep (Video) Centers for Disease Control and Prevention: Pregnancy Depression During and After Pregnancy

in December 2018. Supervisor Rowe served on the Yucca Valley Town Council from 2010 to 2014.  Supervisor Rowe represents one of the largest districts in the county, spanning the Mojave Basin to the mountain communities and the city of Barstow to the valley communities. Supervisor Rowe was appointed to the IEHP Governing Board in January 2021.  

ities of Canyon Lake, Corona, Eastvale, Jurupa Valley, Lake Elsinore, and Norco, along with the unincorporated communities of Coronita, El Cerrito, Gavilan Hills, Home Gardens, Lake Mathews, Lakeland Village, Temescal Valley, Warm Springs, Woodcrest. She was appointed to the IEHP Governing Board in February 2019, became vice chair in January 2020 and chair in 2021. Supervisor Spiegel began her political career as the elected city treasurer for the city of Corona in 1996. She continued her service in Corona as a council member for 16 years and as mayor for four terms.  

ted to the Moreno Valley City Council in 2013, also serving as a three-term mayor and the city’s first directly elected mayor. Supervisor Gutierrez grew up in Moreno Valley, attending all local public schools. He went on to earn an associate degree from Moreno Valley College, a bachelor’s from California Baptist University, a master’s in education from American InterContinental University and a doctoral degree in special education from Northcentral University. He was appointed to the IEHP Governing Board in January 2023.  

en to the public. View Meeting Agenda and More.

California State Assembly from 2008 to 2014 and represented communities in San Bernardino, Orange and Los Angeles counties.  Supervisor Hagman was appointed to the IEHP Governing Board in January 2015, became vice chair in February 2017, and served three years as chair beginning in January 2018. Supervisor Hagman has an extensive resume of public service prior to his state office election.  

tional management, research and quality improvement. She was first appointed to the IEHP Governing Board in January 2003.  Ms. Zorn was appointed vice chair in February 2015 and chair in February 2016. Ms. Zorn has published many health care-related articles and has received many recognitions and awards during her career.  

nprofit sector. Mr. Anderson has spent the last 15 years advocating health care access for low-income and uninsured residents. In April 2008, he was appointed to the IEHP Governing Board and served as the vice chair from January 2018 to December 2020.  Mr. Anderson has addressed the health needs of underserved and uninsured residents in his many lectures and presentations to the community. He is currently the president/CEO of Riverside Community Health Foundation.  

l eligible, Please contact the Department of Health Care Services at (916) 445-9891 or visit DHCS.ca.gov/PI. Operating hours: 8am – 12pm and 1pm – 5pm, Monday through Friday. Closed on weekends and holidays. Mailing address: Department of Health Care Services Third Party Liability and Recovery Division Casualty Insurance Section – MS 4720 P.O. Box 997425 Sacramento, CA 95899-7425 IEHP DualChoice (HMO D-SNP) Medicare-Medicaid Plan Members If you are a Medicare Member and would like to report a potential liability settlement, judgment, award or other payment you have received, or to request your Protected Health Information, please click here for Authorization of Release (PDF).  

sitors to iehp.org need to be in control of their personal information.  Therefore, the following is IEHP’s Internet Privacy Policy: You do not have to give us personal information to visit our site. If you choose not to provide personal information, you can still visit iehp.org. Cookies What is a cookie? A cookie is a small piece of information that is sent to your browser – along with a Web page – when you access a Web site. There are two kinds of cookies. A session cookie is a line of text that is stored temporarily in your computer's memory. Because a session cookie is never saved, it is destroyed as soon as you close your browser. A persistent cookie is a more permanent line of text that gets saved by your browser to a file on your hard drive. IEHP uses session cookies only. We do not use any persistent cookies. IEHP's Use of Cookies Certain applications on the iehp.org web site require session cookies to function correctly. If you have session cookies disabled, you may not be able to use these applications or features of our site. Where they are used, IEHP's session cookies remember your selection criteria. For example, if you use the "Screen Reader Friendly" version of iehp.org with cookies disabled, you will need to choose this option for every page. If you have cookies enabled, this preference will be remembered for the duration of your visit. You do not need to have session cookies enabled to view static web content on iehp.org. We have set our software so that your browser will only return cookie information to iehp.org. No other site can request it. Note: Regardless of the particular uses for cookies on IEHP website, we will not share any cookie information with any third parties. Linking to other sites From time to time we will provide links to other websites, not owned or controlled by IEHP. We do this because we think this information might be of interest or use to you or where, as a Member, we can provide you with additional information and/or services. While we do our best to ensure your privacy, we cannot be responsible for the privacy practices of other sites. A link to a non-IEHP Web site does not constitute or imply endorsement by IEHP. Additionally, we cannot guarantee the quality or accuracy of information presented on non-IEHP websites. We encourage you to review the privacy practices of any website you visit. The IEHP website clearly displays when a User is leaving the home website and going to a linked site. How will information collected about me be used? We may collect personally identifiable information (name, e-mail address, physical address, and other unique identifiers) only if specifically and knowingly provided by you. Personally identifying information collected, such as information you give us when submitting a grievance, will be used only in connection with iehp.org, or for such purposes as are described at the point of collection. IEHP will protect the personal information that you share with us. IEHP does not disclose, give, sell, or transfer any personal information to third parties. If we share demographic information with third parties, we will give them aggregate information only. Information collected is for statistical purposes. IEHP performs analyses of user behavior in order to measure Member interest in the various areas of our sites.  To change any information that you provided to us online, call IEHP Member Services at 1-800-440-IEHP (4347)/TTY (909) 890-0731. We manage and maintain retained personal health information for six years in compliance with federal and state regulations. Deletion and/or removals are handled in accordance with Grievance Policy and Procedures: Deletions and Removals. Use of Electronic Mail While IEHP will make every attempt to protect the personal information that you share with us, electronic mail is not secure against interception. If your communication is very sensitive, you may want to send it by mail instead. Or call IEHP Member Services at 1-800-440-IEHP (4347)/TTY (909) 890-0731. We want to be very clear: We will not obtain personally identifying information about you when you visit our site, unless you choose to provide such information. E-mail sent to Member Services at memberservices@iehp.org will be responded to within 24 hours. Grievances submitted online will be acknowledged in writing within 5 calendar days. Requesting Policy and Procedures You can view our Policy and Procedures detailing editorial policies, security, accountability, and access online, or request a copy by calling IEHP Member Services at 1-800-440-IEHP (4347)/TTY (909) 890-0731. Changes to Our Web Privacy Statement The foregoing Web Privacy Statement, effective September 1, 2002, was revised on July 8, 2004. IEHP may change this statement from time to time without notice. This statement is not intended to and does not create any contractual or other legal right in or on behalf of any party. Protect yourself against email scams called “phishing” or “spoof” emails. Protecting Member privacy is a priority at IEHP. We also strongly encourage our Members to take every precaution in guarding their personal information against the Email scam known as “phishing.” Spoofing and phishing are two different, but interrelated, techniques employed by scammers to steal your personal information. Spoofing refers to the practice of "impersonating" someone else in an e-mail or on the Web. Phishing attempts to trick users into revealing their private information, usually in tandem with a spoofed e-mail and Web page. What is Email phishing? “Phishing” is designed to steal identities. Through fraudulent Emails masking as emails from legitimate businesses, criminals attempt to con individuals into providing personal information such as credit card numbers, passwords, account data, or other valuable information. How does Email phishing work? The Emails usually display well-known brand names such as your bank, your insurance carrier, or even your wireless provider. These deceptive emails are called "Spoof Emails" because they fake the appearance of a popular website or company in an attempt to commit identity theft. Typically, the Email tries to create a sense of urgency, requesting that the recipient update or confirm their personal information. Links may be provided to a website that may also display the company logo or other well-known elements of the company. What to watch out for: Generic greetings. Instead of using your name, many fraudulent emails begin with a general greeting, such as: "Dear [Company Name] customer”. (IEHP will always send emails that include either your Member ID number or your full name in each email.) A false sense of urgency. The Email will attempt to deceive you with the threat that your account is in jeopardy if you don't update your information as soon as possible.  Fake links. The text in a link may look valid, and then send you to a “spoof” address. Always check where a link is going before you click. Move your mouse over it and look at the URL on your browser or status bar. If it looks suspicious, don’t click on the link. What happens if I receive an Email that is fraudulent or seems to be fraudulent?  We suggest that you do not respond to the Email or the Email address in the body of the message. If you receive a suspicious Email purporting to be from IEHP, please contact IEHP Member Services immediately by calling 1-800-440-IEHP. Practice good general computer security measures. This includes installing and maintaining antivirus and firewall software. Some phishing e-mails include spyware that can track your Internet activity and compromise the security of your system. Note: IEHP does not send Email notices asking for customer payment information, username, or passwords used to manage account. Messages and transactions Comments or questions sent to us using e-mail or secure messaging forms may be shared with IEHP staff and health care professionals who are most able to address your concerns. We will archive your messages once we have made our best effort to provide you with a complete and satisfactory response. All IEHP staff considers Member information confidential. Your Privacy is priority to IEHP.   When you use a service on the secure section of this Web site to interact directly with IEHP health care professionals, some information you provide may be documented in your medical record, and available for use to guide your treatment as a patient. Children  We do not knowingly allow IEHP Members under the age of 18 to create accounts that allow access to the secured features of this site. Opt out  If a user makes a request to receive information in an ongoing manner through this Web site by providing their e-mail address (for example, requesting a subscription to one of our online publications), a user may make a request to discontinue future mailings. Similarly, if you receive information about an IEHP service through e-mail, you may make a request to discontinue receiving similar messages in the future. All such materials sent to you by e-mail will contain information about how to opt out. To stop receiving emails from IEHP, log into your Member account. Click on your “Update Profile” tab and uncheck the box stating, “Email Contact” (do so for each Member in your family). Also, if as a member you register to use protected features on our Web site, you may be given an opportunity to receive e-mails about different types of IEHP products, services, announcements, and updates. You may change your preferences anytime by calling IEHP Member Services at 1-800-440-IEHP. Again, we hope to make your online experience enjoyable and secure. Thank you for taking the time to read this Privacy Statement.   Sharing Your Health Information Privacy guidance when selecting third-party apps We are required to provide you with access to detailed information about your health history through a “Patient Access API.” While you are a current member, you may access this information by downloading an application (app) on your smartphone, tablet, computer, or other similar device. The information available through the Patient Access API includes information we collect about you while you have been enrolled in certain lines of business since January 1, 2016. The information includes the following information for as long as we maintain it in our records: Claims and encounter data concerning your interactions with health care providers Clinical data that we collect in the process of providing case management, care coordination, or other services to you. The information we will disclose may include information about treatment for substance use disorders, mental health treatment, HIV status, or other sensitive information. It is important for you to understand that the app you select will have access to all your information. The app may not be subject to the Health Insurance Portability and Accountability Act (HIPAA) rules and other privacy laws, which generally protect your health information. Instead, the app’s privacy policy describes self-imposed limitations on how the app will use, disclose, and (possibly) sell information about you. It is important for you to know once we send your data to the app, we no longer control how the app uses or shares your information. If you decide to access your information through the Patient Access API, you should carefully review the privacy policy of any app you are considering using to ensure you are comfortable with what the app may do with your information. IEHP asks that any app developer planning to access the IEHP Patient Access API attest that it complies with basic privacy and security standards, but you can consent to sharing your data with the app even if they do not attest. When you access a third-party app and select to share your data, IEHP will provide a warning to you if an app did not attest that it complies with basic privacy and security standards. Things you may wish to consider when selecting an app: Will this app sell my data for any reason? Will this app disclose my data to third parties for purposes such as research or advertising? How will this app use my data? For what purposes? Will the app allow me to limit how it uses, discloses, or sells my data? If I no longer want to use this app, or if I no longer want this app to have access to my health information, can I terminate the app’s access to my data? If so, how difficult will it be to terminate access? What is the app’s policy for deleting my data once I terminate access? Do I have to do more than just delete the app from my device? How will this app inform me of changes in its privacy practices? Will the app collect non-health data from my device, such as my location? What security measures does this app use to protect my data? What impact could sharing my data with this app have on others, such as my family members? Will the app permit me to access my data and correct inaccuracies? (Note that correcting inaccuracies in data collected by the app will not affect inaccuracies in the source of the data.) Does the app have a process for collecting and responding to user complaints? If the app’s privacy policy does not satisfactorily answer these questions, you may wish to reconsider using the app to access your health information. Your health information may include very sensitive information. You should therefore be careful to choose an app with strong privacy and security standards to protect it. Covered entities and HIPAA enforcement The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) enforces the HIPAA Privacy, Security, and Breach Notification Rules. IEHP is subject to HIPAA as are most health plans and health care providers, such as hospitals, doctors, and clinics. You can: Find more information about your rights under HIPAA and who is obligated to comply with HIPAA Learn more about filing a complaint with OCR related to HIPAA requirements File a complaint by calling 1-800-440-4347; or completing the grievance form on our website here: GRIEVANCE FORM. Apps and privacy enforcement An app generally will not be subject to HIPAA. An app that publishes a privacy notice is required to comply with the terms of its notice, but generally is not subject to other privacy laws. The Federal Trade Commission Act protects against deceptive acts (such as an app that discloses personal data in violation of its privacy notice). An app that violates the terms of its privacy notice may be subject to the jurisdiction of the Federal Trade Commission (FTC). The FTC provides information about mobile app privacy and security for consumers. If you believe an app inappropriately used, disclosed, or sold your information, you should contact the FTC and file a complaint.      

de and San Bernardino counties. Visit our Community Calendar to find upcoming partner events near you. How can you become a Community Partner with IEHP? Read about the Community Partner Network Meeting to learn more. Please contact our Community Outreach Team for help.  If your organization is interested in becoming an IEHP Community Partner, please sign up here.  How can I find resources in my community? ConnectIE is a new one-stop, interactive website that makes it easy to link people to community resources in the Inland Empire. Visit ConnectIE to find out more!  

ng appeals with problems related to your benefits and coverage. It also includes problems with payment. You are not responsible for Medicare costs except for Part D copays. How to ask for coverage decision coverage decision to get medical, behavioral health, or certain long-term services and supports (CBAS, or NF services)  To ask for a coverage decision, call, write, or fax us, or ask your representative or doctor to ask us for an coverage decision.  You can call us at: (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays, TTY (800) 718-4347.  You can fax us at: (909) 890-5877  You can to write us at: IEHP DualChoice P.O. Box 1800 Rancho Cucamonga, CA 91729-1800. How long does it take to get a coverage decision coverage decision for Part C services? It usually takes up to 14 calendar days after you asked. If we don’t give you our decision within 14 calendar days, you can appeal. Sometimes we need more time, and we will send you a letter telling you that we need to take up to 14 calendar more days. The letter will explain why more time is needed. Can I get a coverage decision faster for Part C services? Yes. If you need a response faster because of your health, you should ask us to make a “fast coverage decision.”  If we approve the request, we will notify you of our coverage decision coverage decision within 72 hours. However, sometimes we need more time, and we will send you a letter telling you that we need to take up to 14 more calendar days. Asking for a fast coverage decision coverage decision: If you request a fast coverage decision coverage decision, start by calling or faxing our plan to ask us to cover the care you want.  You can call IEHP DualChoice at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call (800) 718-4347 or fax us at (909) 890-5877. You can also have your doctor or your representative call us. Here are the rules for asking for a fast coverage decision coverage decision:  You must meet the following two requirements to get a fast coverage decision coverage decision:  You can get a fast coverage decision coverage decision only if you are asking for coverage for care or an item you have not yet received. (You cannot get a fast coverage decision coverage decision if your request is about payment for care or an item you have already received.) You can get a fast coverage decision only if the standard 14 calendar day deadline could cause serious harm to your health or hurt your ability to function.  If your doctor says that you need a fast coverage decision, we will automatically give you one. If you ask for a fast coverage decision, without your doctor’s support, we will decide if you get a fast coverage decision.  If we decide that your health does not meet the requirements for a fast coverage decision, we will send you a letter. We will also use the standard 14 calendar day deadline instead. This letter will tell you that if your doctor asks for the fast coverage decision, we will automatically give a fast coverage decision. The letter will also tell how you can file a “fast appeal” about our decision to give you a fast coverage decision instead of the fast coverage decision you requested. If the coverage decision is Yes, when will I get the service or item? You will be able to get the service or item within 14 calendar days (for a standard coverage decision) or 72 hours (for a fast coverage decision) of when you asked. If we extended the time needed to make our coverage decision, we will provide the coverage by the end of that extended period. If the coverage decision is No, how will I find out?  If the answer is No, we will send you a letter telling you our reasons for saying No. If we say no, you have the right to ask us to change this decision by making an appeal. Making an appeal means asking us to review our decision to deny coverage. If you decide to make an appeal, it means you are going on to Level 1 of the appeals process. Appeals What is an Appeal? An appeal is a formal way of asking us to review our decision and change it if you think we made a mistake. For example, we might decide that a service, item, or drug that you want is not covered or is no longer covered by Medicare or Medi-Cal. If you or your doctor disagree with our decision, you can appeal. In most cases, you must start your appeal at Level 1. If you do not want to first appeal to the plan for a Medi-Cal service, in special cases you can ask for an Independent Medical Review. If you need help during the appeals process, you can call the Office of the Ombudsman at 1-888-452-8609. The Office of Ombudsman is not connected with us or with any insurance company or health plan. What is a Level 1 Appeal for Part C services? A Level 1 Appeal is the first appeal to our plan. We will review our coverage decision to see if it is correct. The reviewer will be someone who did not make the original coverage decision. When we complete the review, we will give you our decision in writing. If we tell you after our review that the service or item is not covered, your case can go to a Level 2 Appeal.  Can someone else make the appeal for me for Part C services? Yes. Your doctor or other provider can make the appeal for you. Also, someone besides your doctor or other provider can make the appeal for you, but first you must complete an Appointment of Representative Form. The form gives the other person permission to act for you. If the appeal comes from someone besides you or your doctor or other provider, we must receive the completed Appointment of Representative form before we can review the appeal. How do I make a Level 1 Appeal for Part C services? To start your appeal, you, your doctor or other provider, or your representative must contact us. You can call IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY should call (800) 718-4347. For additional details on how to reach us for appeals, see Chapter 9 of the IEHP DualChoice Member Handbook. You can ask us for a “standard appeal” or a “fast appeal.” If you are asking for a standard appeal or fast appeal, make your appeal in writing: IEHP DualChoice P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Fax: (909) 890-5748 You may also ask for an appeal by calling IEHP DualChoice Member Services at (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY should call (800) 718-4347. We will send you a letter within 5 calendar days of receiving your appeal letting you know that we received it. How much time do I have to make an appeal for Part C services? You must ask for an appeal within 60 calendar days from the date on the letter we sent to tell you our decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal. Examples of a good reason are: you had a serious illness, or we gave you the wrong information about the deadline for requesting an appeal. Can I get a copy of my case file? Yes. Ask us for a copy by calling Member Services at (877) 273-IEHP (4347). TTY (800) 718-4347. Can my doctor give you more information about my appeal for Part C services? Yes, you and your doctor may give us more information to support your appeal. How will the plan make the appeal decision?  We take a careful look at all of the information about your request for coverage of medical care. Then, we check to see if we were following all the rules when we said No to your request. The reviewer will be someone who did not make the original decision. If we need more information, we may ask you or your doctor for it.  When will I hear about a “standard” appeal decision for Part C services? We must give you our answer within 30 calendar days after we get your appeal. We will give you our decision sooner if your health condition requires us to. However, if you ask for more time, or if we need to gather more information, we can take up to 14 more calendar days. If we decide to take extra days to make the decision, we will tell you by letter. If you believe we should not take extra days, you can file a “fast complaint” about our decision to take extra days. When you file a fast complaint, we will give you an answer to your appeal within 24 hours. If we do not give you an answer within 30 calendar days or by the end of the extra days (if we took them), we will automatically send your case to Level 2 of the appeals process if your problem is about a Medicare service or item. You will be notified when this happens. If your problem is about a Medi-Cal service or item, you will need to file a Level 2 Appeal yourself. Please see below for more information.  If our answer is Yes to part or all of what you asked for, we must approve or give the coverage within 30 calendar days after we get your appeal. If our answer is No to part or all of what you asked for, we will send you a letter. If your problem is about a Medicare service or item, the letter will tell you that we sent your case to the Independent Review Entity for a Level 2 Appeal. If your problem is about a Medi-Cal service or item, the letter will tell you how to file a Level 2 Appeal yourself. Please see below for more information. What happens if I ask for a fast appeal? If you ask for a fast appeal, we will give you your answer within 72 hours after we get your appeal. We will give you our answer sooner if your health requires us to do so. However, if you ask for more time, or if we need to gather more information, we can take up to 14 more calendar days. If we decide to take extra days to make the decision, we will tell you by letter. If you believe we should not take extra days, you can file a “fast complaint” about our decision to take extra days. When you file a fast complaint, we will give you an answer to your appeal within 24 hours. If we do not give you an answer within 72 hours or by the end of the extra days (if we took them), we will automatically send your case to Level 2 of the appeals process if your problem is about a Medicare service or item. You will be notified when this happens. If your problem is about a Medi-Cal service or item, you will need to file a Level 2 Appeal yourself. Please see below for more information. If our answer is Yes to part or all of what you asked for, we must authorize or provide the coverage within 72 hours after we get your appeal.  If our answer is No to part or all of what you asked for, we will send you a letter. If your problem is about a Medicare service or item, the letter will tell you that we sent your case to the Independent Review Entity for a Level 2 Appeal. If your problem is about a Medi-Cal service or item, the letter will tell you how to file a Level 2 Appeal yourself. Please see below for more information. Will my benefits continue during Level 1 appeals? If we decide to change or stop coverage for a service or item that was previously approved, we will send you a notice before taking the action. If you disagree with the action, you can file a Level 1 Appeal and ask that we continue your benefits for the service or item. You must make the request on or before the later of the following in order to continue your benefits: Within 10 days of the mailing date of our notice of action; or The intended effective date of the action. If you meet this deadline, you can keep getting the disputed service or item while your appeal is processing. Level 2 Appeal If the plan says No at Level 1, what happens next? If we say no to part or all of your Level 1 Appeal, we will send you a letter. This letter will tell you if the service or item is usually covered by Medicare or Medi-Cal. If your problem is about a Medicare service or item, we will automatically send your case to Level 2 of the appeals process as soon as the Level 1 Appeal is complete. If your problem is about a Medi-Cal service or item, you can file a Level 2 Appeal yourself. The letter will tell you how to do this. Information is also below. What is a Level 2 Appeal? A Level 2 Appeal is the second appeal, which is done by an independent organization that is not connected to the plan.   My problem is about a Medi-Cal service or item. How can I make a Level 2 Appeal? There are two ways to make a Level 2 appeal for Medi-Cal services and items: 1) Independent Medical Review or 2) State Hearing. 1)    Independent Medical Review You can ask for an Independent Medical Review (IMR) from the Help Center at the California Department of Managed Health Care (DMHC). An IMR is available for any Medi-Cal covered service or item that is medical in nature. An IMR is a review of your case by doctors who are not part of our plan. If the IMR is decided in your favor, we must give you the service or item you requested. You pay no costs for an IMR. You can apply for an IMR if our plan: Denies, changes, or delays a Medi-Cal service or treatment (not including IHSS) because our plan determines it is not medically necessary. Will not cover an experimental or investigational Medi-Cal treatment for a serious medical condition. Will not pay for emergency or urgent Medi-Cal services that you already received. Has not resolved your Level 1 Appeal on a Medi-Cal service within 30 calendar days for a standard appeal or 72 hours for a fast appeal. You can ask for an IMR if you have also asked for a State Hearing, but not if you have already had a State Hearing, on the same issue. In most cases, you must file an appeal with us before requesting an IMR. If you disagree with our decision, you can ask the DMHC Help Center for an IMR. If your treatment was denied because it was experimental or investigational, you do not have to take part in our appeal process before you apply for an IMR. If your problem is urgent and involves an immediate and serious threat to your health, you may bring it immediately to the DMHC’s attention. The DMHC may waive the requirement that you first follow our appeal process in extraordinary and compelling cases. You must apply for an IMR within 6 months after we send you a written decision about your appeal. The DMHC may accept your application after 6 months if it determines that circumstances kept you from submitting your application in time. To ask for an IMR: Fill out the Independent Medical Review/Complaint Form available at: http://www.dmhc.ca.gov/FileaComplaint/SubmitanIndependentMedicalReviewComplaintForm.aspx or call the DMHC Help Center at (888) 466-2219. TDD users should call (877) 688-9891. If you have them, attach copies of letters or other documents about the service or item that we denied. This can speed up the IMR process. Send copies of documents, not originals. The Help Center cannot return any documents. Fill out the Authorized Assistant Form if someone is helping you with your IMR. You can get the form at http://www.dmhc.ca.gov/FileaComplaint/SubmitanIndependentMedicalReviewComplaintForm.aspx Or call the DMHC Help Center at (888) 466-2219. TDD users should call (877) 688-9891. Mail or fax your forms and any attachments to:  Help Center Department of Managed Health Care 980 Ninth Street, Suite 500 Sacramento, CA 95814-2725 FAX: 916-255-5241 If you qualify for an IMR, the DMHC will review your case and send you a letter within 7 calendar days telling you that you qualify for an IMR. After your application and supporting documents are received from your plan, the IMR decision will be made within 30 calendar days. You should receive the IMR decision within 45 calendar days of the submission of the completed application. If your case is urgent and you qualify for an IMR, the DMHC will review your case and send you a letter within 2 calendar days telling you that you qualify for an IMR. After your application and supporting documents are received from your plan, the IMR decision will be made within 3 calendar days. You should receive the IMR decision within 7 calendar days of the submission of the completed application. If you are not satisfied with the result of the IMR, you can still ask for a State Hearing.  If the DMHC decides that your case is not eligible for IMR, the DMHC will review your case through its regular consumer complaint process. 2)    State Hearing You can ask for a State Hearing for Medi-Cal covered services and items. If your doctor or other provider asks for a service or item that we will not approve, or we will not continue to pay for a service or item you already have and we said no to your Level 1 appeal, you have the right to ask for a State Hearing. In most cases you have 120 days to ask for a State Hearing after the “Your Hearing Rights” notice is mailed to you.  NOTE: If you ask for a State Hearing because we told you that a service you currently get will be changed or stopped, you have fewer days to submit your request if you want to keep getting that service while your State Hearing is pending. Read “Will my benefits continue during Level 2 appeals” in Chapter 9 of the Member Handbook for more information. There are two ways to ask for a State Hearing: You may complete the "Request for State Hearing" on the back of the notice of action. You should provide all requested information such as your full name, address, telephone number, the name of the plan or county that took the action against you, the aid program(s) involved, and a detailed reason why you want a hearing. Then you may submit your request one of these ways: To the county welfare department at the address shown on the notice. To the California Department of Social Services: State Hearings Division P.O. Box 944243, Mail Station 9-17-37 Sacramento, California 94244-2430 To the State Hearings Division at fax number 916-651-5210 or 916-651-2789. You can call the California Department of Social Services at (800) 952-5253. TDD users should call (800) 952-8349. If you decide to ask for a State Hearing by phone, you should be aware that the phone lines are very busy. Will my benefits continue during Level 2 appeals? If your problem is about a service or item covered by Medicare, your benefits for that service or item will not continue during the Level 2 appeals process with the Independent Review Entity. If your problem is about a service or item covered by Medi-Cal and you ask for a State Fair Hearing, your Medi-Cal benefits for that service or item will continue until a hearing decision is made. You must ask for a hearing on or before the later of the following in order to continue your benefits: Within 10 days of the mailing date of our notice to you that the adverse benefit determination (Level 1 appeal decision) has been upheld; or The intended effective date of the action. If you meet this deadline, you can keep getting the disputed service or item until the hearing decision is made. How will I find out about the decision? If your Level 2 Appeal was a State Hearing, the California Department of Social Services will send you a letter explaining its decision.  If the State Hearing decision is Yes to part or all of what you asked for, we must comply with the decision. We must complete the described action(s) within 30 calendar days of the date we received a copy of the decision. If the State Hearing decision is No to part or all of what you asked for, it means they agree with the Level 1 decision. We may stop any aid paid pending you are receiving.  If your Level 2 Appeal was an Independent Medical Review, the Department of Managed Health Care will send you a letter explaining its decision.  If the Independent Medical Review decision is Yes to part or all of what you asked for, we must provide the service or treatment. If the Independent Medical Review decision is No to part or all of what you asked for, it means they agree with the Level 1 decision. You can still get a State Hearing. If your Level 2 Appeal went to the Medicare Independent Review Entity, it will send you a letter explaining its decision. If the Independent Review Entity says Yes to part or all of what you asked for, we must authorize the medical care coverage within 72 hours or give you the service or item within 14 calendar days from the date we receive the IRE’s decision.  If the Independent Review Entity says No to part or all of what you asked for, it means they agree with the Level 1 decision. This is called “upholding the decision.” It is also called “turning down your appeal.” If the decision is No for all or part of what I asked for, can I make another appeal? If your Level 2 Appeal was a State Hearing, you may ask for a rehearing within 30 days after you receive the decision. You may also ask for judicial review of a State Hearing denial by filing a petition in Superior Court (under Code of Civil Procedure Section 1094.5) within one year after you receive the decision.  If your Level 2 Appeal was an Independent Medical Review, you can request a State Hearing.  If your Level 2 Appeal went to the Medicare Independent Review Entity, you can appeal again only if the dollar value of the service or item you want meets a certain minimum amount. The letter you get from the IRE will explain additional appeal rights you may have. Payment Problems We do not allow our network providers to bill you for covered services and items. This is true even if we pay the provider less than the provider charges for a covered service or item. You are never required to pay the balance of any bill. The only amount you should be asked to pay is the copay for service, item, and/or drug categories that require a copay. If you get a bill that is more than your copay for covered services and items, send the bill to us. You should not pay the bill yourself. We will contact the provider directly and take care of the problem. How do I ask the plan to pay me back for the plan’s share of medical services or items I paid for? Remember, if you get a bill that is more than your copay for covered services and items, you should not pay the bill yourself. But if you do pay the bill, you can get a refund if you followed the rules for getting services and items.  If you are asking to be paid back, you are asking for a coverage decision. We will see if the service or item you paid for is a covered service or item, and we will check to see if you followed all the rules for using your coverage. If the service or item you paid for is covered and you followed all the rules, we will send you the payment for our share of the cost of the service or item within 60 calendar days after we get your request. Or, if you haven’t paid for the service or item yet, we will send the payment directly to the provider. When we send the payment, it’s the same as saying Yes to your request for a coverage decision. If the service or item is not covered, or you did not follow all the rules, we will send you a letter telling you we will not pay for the service or item and explaining why. What if the plan says they will not pay? If you do not agree with our decision, you can make an appeal. Follow the appeals process. When you are following these instructions, please note: If you make an appeal for reimbursement, we must give you our answer within 60 calendar days after we get your appeal. If you are asking us to pay you back for medical care you have already received and paid for yourself, you are not allowed to ask for a fast appeal.  If we answer “no” to your appeal and the service or item is usually covered by Medicare, we will automatically send your case to the Independent Review Entity. We will notify you by letter if this happens. If the IRE reverses our decision and says we should pay you, we must send the payment to you or to the provider within 30 calendar days. If the answer to your appeal is Yes at any stage of the appeals process after Level 2, we must send the payment you asked for to you or to the provider within 60 calendar days. If the IRE says No to your appeal, it means they agree with our decision not to approve your request. (This is called “upholding the decision.” It is also called “turning down your appeal.”) The letter you get will explain additional appeal rights you may have. You can appeal again only if the dollar value of the service or item you want meets a certain minimum amount. If we answer “no” to your appeal and the service or item is usually covered by Medi-Cal, you can file a Level 2 Appeal yourself (see above). IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal. Information on this page is current as of October 01, 2022. H8894_DSNP_23_3241532_M

have problems getting a Part D drug or you want us to pay you back for a Part D drug. Your benefits as a member of our plan include coverage for many prescription drugs. Most of these drugs are “Part D drugs.” There are a few drugs that Medicare Part D does not cover but that Medi-Cal may cover. Can I ask for a coverage determination or make an appeal about Part D prescription drugs? Yes. Here are examples of coverage determination you can ask us to make about your Part D drugs.  You ask us to make an exception such as: Asking us to cover a Part D drug that is not on the plan’s List of Covered Drugs (Formulary) Asking us to waive a restriction on the plan’s coverage for a drug (such as limits on the amount of the drug you can get) You ask us if a drug is covered for you (for example, when your drug is on the plan’s Formulary but we require you to get approval from us before we will cover it for you). Please note: If your pharmacy tells you that your prescription cannot be filled, you will get a notice explaining how to contact us to ask for a coverage determination. You ask us to pay for a prescription drug you already bought. This is asking for a coverage determination about payment. If you disagree with a coverage decision we have made, you can appeal our decision. What is an exception? An exception is permission to get coverage for a drug that is not normally on our List of Covered Drugs, or to use the drug without certain rules and limitations. If a drug is not on our List of Covered Drugs, or is not covered in the way you would like, you can ask us to make an “exception.” When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception. Here are examples of exceptions that you or your doctor or another prescriber can ask us to make:  Covering a Part D drug that is not on our List of Covered Drugs (Formulary). If we agree to make an exception and cover a drug that is not on the Formulary, you will need to pay the cost-sharing amount that applies to drug. You cannot ask for an exception to the copayment or coinsurance amount we require you to pay for the drug. Removing a restriction on our coverage. There are extra rules or restrictions that apply to certain drugs on our Formulary. The extra rules and restrictions on coverage for certain drugs include: Being required to use the generic version of a drug instead of the brand name drug. Getting plan approval before we will agree to cover the drug for you. (This is sometimes called “prior authorization.”) Being required to try a different drug first before we will agree to cover the drug you are asking for. (This is sometimes called “step therapy.”) Quantity limits. For some drugs, the plan limits the amount of the drug you can have. If we agree to make an exception and waive a restriction for you, you can still ask for an exception to the co-pay amount we require you to pay for the drug. Important things to know about asking for exceptions Your doctor or other prescriber must give us a statement explaining the medical reasons for requesting an exception. Our decision about the exception will be faster if you include this information from your doctor or other prescriber when you ask for the exception. Typically, our Formulary includes more than one drug for treating a particular condition. These different possibilities are called “alternative” drugs. If an alternative drug would be just as effective as the drug you are asking for, and would not cause more side effects or other health problems, we will generally not approve your request for an exception. We will say Yes or No to your request for an exception. If we say Yes to your request for an exception, the exception usually lasts until the end of the calendar year. This is true as long as your doctor continues to prescribe the drug for you and that drug continues to be safe and effective for treating your condition. If we say No to your request for an exception, you can ask for a review of our decision by making an appeal. Coverage Decision What to do Ask for the type of coverage decision you want. Call, write, or fax us to make your request. You, your representative, or your doctor (or other prescriber) can do this.   You can call us at: (877) 273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. You can fax us at: (909) 890-5877  You can to write us at: IEHP DualChoice P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 You or your doctor (or other prescriber) or someone else who is acting on your behalf can ask for a coverage decision. You can also have a lawyer act on your behalf. You do not need to give your doctor or other prescriber written permission to ask us for a coverage determination on your behalf. If you are requesting an exception, provide the “supporting statement.” Your doctor or other prescriber must give us the medical reasons for the drug exception. We call this the “supporting statement.”  Your doctor or other prescriber can fax or mail the statement to us. Or your doctor or other prescriber can tell us on the phone, and then fax or mail a statement. Request for Medicare Prescription Drug Coverage Determination (PDF) These forms are also available on the CMS website: Medicare Prescription Drug Determination Request Form (for use by enrollees and providers) By clicking on this link, you will be leaving the IEHP DualChoice website. Deadlines for a “standard coverage decision” about a drug you have not yet received If we are using the standard deadlines, we must give you our answer within 72 hours after we get your request or, if you are asking for an exception, after we get your doctor’s or prescriber’s supporting statement. We will give you our answer sooner if your health requires it. If we do not meet this deadline, we will send your request on to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review the decision. If our answer is Yes to part or all of what you asked for, we must approve or give the coverage within 72 hours after we get your request or, if you are asking for an exception, your doctor’s or prescriber’s supporting statement.  If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. The letter will also explain how you can appeal our decision. Deadlines for a “standard coverage decision” about payment for a drug you have already bought We must give you our answer within 14 calendar days after we get your request. If we do not meet this deadline, we will send your request to Level 2 of the appeals process. At level 2, an Independent Review Entity will review the decision. If our answer is Yes to part or all of what you asked for, we will make payment to you within 14 calendar days. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. This statement will also explain how you can appeal our decision. If your health requires it, ask us to give you a “fast coverage decision” We will use the “standard deadlines” unless we have agreed to use the “fast deadlines.” A standard coverage decision means we will give you an answer within 72 hours after we get your doctor’s statement. A fast coverage decision means we will give you an answer within 24 hours after we get your doctor’s statement. You can get a fast coverage decision only if you are asking for a drug you have not yet received. (You cannot get a fast coverage decision if you are asking us to pay you back for a drug you have already bought.) You can get a fast coverage decision only if using the standard deadlines could cause serious harm to your health or hurt your ability to function. If your doctor or other prescriber tells us that your health requires a “fast coverage decision,” we will automatically agree to give you a fast coverage decision, and the letter will tell you that. If you ask for a fast coverage decision on your own (without your doctor’s or other prescriber’s support), we will decide whether you get a fast coverage decision. If we decide that your medical condition does not meet the requirements for a fast coverage decision, we will use the standard deadlines instead. We will send you a letter telling you that. The letter will tell you how to make a complaint about our decision to give you a standard decision. You can file a “fast complaint” and get a response to your complaint within 24 hours. Deadlines for a “fast coverage decision” If we are using the fast deadlines, we must give you our answer within 24 hours. This means within 24 hours after we get your request. Or, if you are asking for an exception, 24 hours after we get your doctor’s or prescriber’s statement supporting your request. We will give you our answer sooner if your health requires us to. If we do not meet this deadline, we will send your request on to Level 2 of the appeals process. At Level 2, an outside independent organization will review your request and our decision. If our answer is Yes to part or all of what you asked for, we must give you the coverage within 24 hours after we get your request or your doctor’s or prescriber’s statement supporting your request. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. The letter will also explain how you can appeal our decision. Level 1 Appeal for Part D drugs To start your appeal, you, your doctor or other prescriber, or your representative must contact us. If you are asking for a standard appeal, you can make your appeal by sending a request in writing. You may also ask for an appeal by calling IEHP DualChoice Member Services at 1-877-273-IEHP (4347), 8am – 8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. If you want a fast appeal, you may make your appeal in writing or you may call us. Make your appeal request within 60 calendar days from the date on the notice we sent to tell you our decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make you appeal.  For example, good reasons for missing the deadline would be if you have a serious illness that kept you from contacting us or if we gave you incorrect or incomplete information about the deadline for requesting an appeal. You can ask for a copy of the information in your appeal and add more information. You have the right to ask us for a copy of the information about your appeal.  If you wish, you and your doctor or other prescriber may give us additional information to support your appeal. You may use the following form to submit an appeal: Coverage Determination Form (PDF) Can someone else make the appeal for me? Yes. Your doctor or other provider can make the appeal for you. Also, someone besides your doctor or other provider can make the appeal for you, but first you must complete an Appointment of Representative Form. The form gives the other person permission to act for you. If the appeal comes from someone besides you or your doctor or other provider, we must receive the completed Appointment of Representative form before we can review the appeal.  Deadlines for a “standard appeal” If we are using the standard deadlines, we must give you our answer within 7 calendar days after we get your appeal, or sooner if your health requires it. If you think your health requires it, you should ask for a “fast appeal.” If you are asking us to pay you back for a drug you already bought, we must give you our answer within 14 calendar days after we get your appeal. If we do not give you a decision within 7 calendar days, or 14 days if you asked us to pay you back for a drug you already bought, we will send your request to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review our decision. If your health requires it, ask for a “fast appeal” If you are appealing a decision our plan made about a drug you have not yet received, you and your doctor or other prescriber will need to decide if you need a “fast appeal.” The requirements for getting a “fast appeal” are the same as those for getting a “fast coverage decision.”  Our plan will review your appeal and give you our decision We take another careful look at all of the information about your coverage request. We check to see if we were following all the rules when we said No to your request. We may contact you or your doctor or other prescriber to get more information. Deadlines for a “fast appeal” If we are using the fast deadlines, we will give you our answer within 72 hours after we get your appeal, or sooner if your health requires it. If we do not give you an answer within 72 hours, we will send your request to Level 2 of the appeals process. At Level 2, an Independent Review Entity will review your appeal. If our answer is Yes to part or all of what you asked for, we must give the coverage within 72 hours after we get your appeal. If our answer is No to part or all of what you asked for, we will send you a letter that explains why we said No. Level 2 Appeal for Part D drugs If we say No to your appeal, you then choose whether to accept this decision or continue by making another appeal. If you decide to go on to a Level 2 Appeal, the Independent Review Entity (IRE) will review our decision. If you want the Independent Review Organization to review your case, your appeal request must be in writing.   Ask within 60 days of the decision you are appealing. If you miss the deadline for a good reason, you may still appeal. You, your doctor or other prescriber, or your representative can request the Level 2 Appeal. When you make an appeal to the Independent Review Entity, we will send them your case file. You have the right to ask us for a copy of your case file. You have a right to give the Independent Review Entity other information to support your appeal. The Independent Review Entity is an independent organization that is hired by Medicare. It is not connected with this plan and it is not a government agency. Reviewers at the Independent Review Entity will take a careful look at all of the information related to your appeal. The organization will send you a letter explaining its decision. If we uphold the denial after Redetermination, you have the right to request a Reconsideration. See form below: Reconsideration Form (PDF) Deadlines for a “fast appeal” at Level 2 If your health requires it, ask the Independent Review Entity for a “fast appeal.” If the review organization agrees to give you a “fast appeal,” it must give you an answer to your Level 2 Appeal within 72 hours after getting your appeal request. If the Independent Review Entity says Yes to part or all of what you asked for, we must authorize or give you the drug coverage within 24 hours after we get the decision. Deadlines for “standard appeal” at Level 2 If you have a standard appeal at Level 2, the Independent Review Entity must give you an answer to your Level 2 Appeal within 7 calendar days after it gets your appeal. If the Independent Review Entity says Yes to part or all of what you asked for, we must authorize or give you the drug coverage within 72 hours after we get the decision.   If the Independent Review Entity approves a request to pay you back for a drug you already bought, we will send payment to you within 30 calendar days after we get the decision. What if the Independent Review Entity says No to your Level 2 Appeal? No means the Independent Review Entity agrees with our decision not to approve your request. This is called “upholding the decision.” It is also called “turning down your appeal.” If the dollar value of the drug coverage you want meets a certain minimum amount, you can make another appeal at Level 3. The letter you get from the Independent Review Entity will tell you the dollar amount needed to continue with the appeals process. The Level 3 Appeal is handled by an administrative law judge. For more information see Chapter 9 of your IEHP DualChoice Member Handbook. IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal. Information on this page is current as of October 01, 2022. H8894_DSNP_23_3241532_M

ne year Ages: 18 years and over This online year-long lifestyle change program helps you make real changes that last.  During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned. No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to: Eat healthier Add physical activity into your daily life Reduce stress Improve problem-solving and coping skills Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes. Small changes can have big results! Let's start living the best version of you and living the life you love.  Find out if you qualify! Click here to visit the Skinny Gene Project online, or Text “DPP” to 313131, or Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or Email hello@skinnygeneproject.org Click on the video below to learn more about this program. 

provider, and receive treatment for COVID-19 – all in one place at a Test to Treat site.  If you have a medical condition which makes you more likely to get very sick from COVID-19, you may be eligible to receive treatments.  Adults and Children over the age of 12 can receive treatments, but treatment must be started as soon as possible and within 5 days of symptom onset. Click here for more information on the COVID-19 Test to Treat Program.  Walgreens Test to Treat Program  Select Walgreens pharmacies are now dispensing oral antivirals for the treatment of COVID-19.  Eligible members must have a valid prescription from their healthcare provider. Walgreens offers a variety of delivery options, like same day or free 2-day delivery. Most prescriptions are eligible for Same Day Delivery.  Click here for more information. FREE at-home COVID-19 tests Every home in the U.S. is eligible to order one free COVID-19 test kit, which includes four at-home tests. The tests are completely free. Click here to order your free at-home tests from USPS.  Effective 2/1/22, Medi-Cal Members can receive at-home COVID-19 tests from a Medi-Cal enrolled pharmacy. California Department of Health Care Services (DHCS) will cover up to 8 test kits per month per member. For information on which test kits are covered or if you need assistance with a prescription, please ask your Doctor or your Pharmacist. Medi-Cal Members will be reimbursed for at-home test kits purchased between March 11, 2021, and January 31, 2022, by DHCS the cost (with a receipt) using the process outlined here. San Bernardino County-facilitated testing sites will offer free at-home COVID-19 tests kits to people who live, work, or attend school in San Bernardino County (proof of residency or employment required). Click here to find a list of county-facilitated testing sites. Testing IEHP covers provider-ordered tests, regardless of whether it’s PCR, rapid, at-home, etc. If your doctor orders the test for you, IEHP will cover the cost of the test. Your provider is required to bill IEHP directly for these tests.  IEHP does NOT reimburse Members who choose to pay for COVID tests that are not ordered by a provider.  For information on COVID-19 testing sites in Riverside County, please visit the Riverside County Public Health website. For information on COVID-19 testing sites in San Bernardino County, please visit the San Bernardino County COVID Testing Sites.

our child stay healthy. During the well-care visit, the Doctor will complete a physical exam, and make sure you or your child are up to date on all shots. Please call your Doctor today and set up a well-care visit to get needed shots, screenings or exams. What do you need to do? Get a well-care visit with your or your child’s Doctor by 12/15/23.* The Doctor will send proof of the visit to IEHP. Once IEHP receives proof of the visit, a reward certificate will be mailed.** Choose your gift card from the list of major companies online, over the phone or by mail, and your $25 gift card will be mailed to you.*** Questions? Call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.   *Member must be eligible with IEHP on the day of the exam and at the time of gift card distribution. **Reward certificate may be mailed up to two weeks after IEHP receives proof of your exam. ***After choosing your gift card, please allow two to three weeks for delivery. Note: Gift card cannot be used to purchase alcohol, tobacco or firearms.                                                                

s with your retinas over time. Your retinas are parts of your eyes that help you see. Over a long period of time, blood sugar levels can damage blood vessels in your retinas, leading to retinopathy. This can cause symptoms like swelling, blurred vision or vision loss. Even if you have no symptoms, it’s still a good idea to get a full eye exam to screen for that is not normal. What do you need to do? If you don’t have an IEHP Eye Doctor yet, visit our Provider Search Tool (select Vision Services) to find one near you. Make an appointment with your IEHP Eye Doctor and get a dilated or retinal eye exam by 12/15/2023. The IEHP Eye Doctor will send proof of your exam to IEHP.* Once IEHP gets proof of your exam, we will mail you a reward certificate.** Choose your gift card from the list of major companies online, over the phone or by mail, and your $25 gift card will be mailed to you.** Questions? Call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347.   *You must be eligible with IEHP on the day of your exam or service and at the time the gift card is sent. **Reward may be mailed up to two weeks after IEHP receives proof of your exam. ***After choosing your gift card, please allow two to three weeks for delivery. Note: Gift card cannot be used to purchase alcohol, tobacco or firearms.

Answers What can happen if I take a few medicines at the same time? When you take two or more medicines, they will likely mix well. On certain occasions, you might have what’s called a “drug-to-drug interaction.” This means that some medicines you take together may cause an adverse reaction in your body. For example, a “drug-to-drug” interaction could: make your medicines not work as well (weaken them) make one or more of the medicines too strong and cause unwanted side effects, which could be deadly TIP: Talk to your Pharmacist about all medicines you take and ask if they mix well together. What are some reasons that I might have a harmful effect from taking one or more medicines at the same time? These reasons might include: dose may be too high interaction with other drugs Note: Everyone can react differently – based on age, weight, gender, etc. TIP: To avoid problems when taking two or more medicines together, tell your health care Provider and Pharmacist about all the medicines (and other remedies) you are taking.    How do I know if I’m taking the right medicine – at the right dose, at the right time to control my symptoms? Any medicine taken the wrong way might put your health at risk.  A drug maker has to show research data to the FDA to get each medicine approved. This research could be about: how the medicine works why it is safe to take (or not) what dose works best with the fewest side effects Could a medicine taken at a high dose be harmful? Yes. That is why your Pharmacist checks your medicines to make sure you are on the right dose. Don’t forget to ask your Doctor or Pharmacist any questions about your medicine.  Taking higher than recommended doses of certain over-the-counter (OTC) and prescription medicines – including abuse or misuse of the medicines – can cause serious health problems. It could even lead to death. Also, a dose that is safe for you may not be safe for someone else.     Who most often needs to have their medicine dose changed and why? Certain people need to have their dose changed, so that they don’t take too much (called “overdosing”). These include the elderly, children, and women who are pregnant or mothers who are breastfeeding, and people with chronic health conditions.  Always ask your Pharmacist if the medicines are safe for you to take at the prescribed doses. Don’t share your medicines with friends or family.    What are “duplicate drug therapies”? Why do I need to know about this? You might have different Doctors who have prescribed medicines that work in the same way for you. When medicines have similar active ingredients, they could be:  the same medicine with different names (for example, one could have a brand name and the other might have a generic name), or  two medicines of similar nature TIP: Be cautious about taking the same medicine twice – as you could have two bottles of the same medicine! TIP: It’s important for you to keep a full list of each medicine, vitamin and herbal remedy you are taking. Please show this list to your Pharmacist or your Doctor. The list helps your health care Provider check for any unwanted effects between drugs and check that the two or more medicines work well for you or not. What happens if my medicine is recalled? A recall may be issued if a medication is: A health hazard: If there is some health risk associated with the medication.  Mislabeled or packaged poorly: If there is a problem with the dosing tool provided with the drug.  Poorly manufactured: If there are defects related to poor quality, impurities, and incorrectly potency of the drug from the manufacturer.  Please click here to view an up-to-date list of drug recall notifications. Why are some medicines “high risk” for the elderly?  Some medicines can be too strong for a certain group of people and are considered “high risk” for them. This special group may include older people, pregnant women or mothers who are breastfeeding, children, and people with other medical conditions affecting their kidney or liver. For example, certain medicines prescribed for memory issues may have a side-effect that causes dizziness in some seniors who are at “high risk” for falling. In that case, an alternative medicine (or no medicine) for this condition would be better.   Where can I find details about medicines that might be harmful for older people? If you are over 65 years old, ask your Doctor or Pharmacist if the medicines you are taking may not be right for you.  Please see the short list below of the most common medicines prescribed that may be harmful for older people.  Older adults (age 65+): Check with your Doctor first before taking these medicines: Medicine or Medicine Class   Potential Risks Sliding scale insulin May make your blood sugar level too low – without improving the condition Glyburide  May cause a long period of excessively low blood sugar Muscle relaxants  May be poorly tolerated Barbiturates May increase risk of dependence and overdose Benzodiazepines (alprazolam, temazepam, lorazepam) May increase risk of falls and fractures To learn more, visit: https://www.pharmacytoday.org/article/S1042-0991(19)31235-6/fulltext Pharmacy Benefits: Medi-Cal Members IEHP Dual Choice Cal MediConnect Members

amily of viruses that cause smallpox. Is monkeypox very dangerous?  The Centers for Disease Control and Prevention (CDC) stated that most of those infected recover from monkeypox in two to four weeks. Those who caught the virus said the rash (that looks like pimples or blisters) can be painful.    Those with weakened immune systems, children under age 8, people who are pregnant or breastfeeding, and those with a history of eczema may be more likely to get seriously ill or pass away.  What are the symptoms? The most common symptoms are:  Fever and headache Muscle aches and backache Swollen lymph nodes Exhaustion and chills Sore throat, stuffy nose or cough Rash (i.e., pimples or blisters that show up on the face, inside the mouth and on other body parts) If you have monkeypox symptoms, please call your Doctor’s office. How does monkeypox spread? It is spread through direct contact with someone who has an infected rash, scabs or body fluids. It could also spread through face-to-face contact. Or it can be spread by touching items that had been touched by those with the infection. People who don’t have monkeypox symptoms can’t spread this virus to others. How can I protect myself and my family? Take these precautions:  Avoid skin-to-skin contact with those who have a rash that looks like monkeypox. This rash can look like small blisters or pimples and may be itchy or painful. Avoid contact with surfaces or materials that a person with monkeypox has used or touched. Wash your hands with soap and water for 20 seconds often or use an alcohol-based hand sanitizer. Is there a monkey pox vaccine? JYNNEOS is a 2-dose vaccine developed to protect against monkeypox. The second dose should be given 4 weeks after the first dose. Consult with your health care provider if you are at high risk of exposure or if you were in contact with a person who has monkeypox within the last 2 weeks.  Antiviral drugs used for treatment of smallpox may be considered some instances to treat monkeypox viral infections. Consult with your health care provider for more information.  Who should get this vaccine? The Centers for Disease Control and Prevention (CDC) recommends it for those who have been in close contact with those with monkeypox. While anyone exposed to this monkeypox can become infected, 98% of current infections have been found in men who have sex with men. Talk with your Doctor if you believe you have been exposed to monkeypox. If you have monkeypox symptoms, please call your Doctor’s office. Click here to learn more.  What are the side effects of the vaccine? The most common side effects are pain, redness, and itching at the spot where the vaccine is given. You may also experience fever, headache, tiredness, nausea, chills, and muscle aches; however, these are signs that the vaccine is working, not getting sick. These side effects may last for several weeks. Is the vaccine safe? The vaccine is safe to get. However, you should not get the vaccine if you have a severe allergic reaction (anaphylaxis) after getting your first dose of the JYNNEOS vaccine. Make sure to let your health care provider know if you have a severe allergic reaction from any vaccinations. Do I have to pay for the vaccine? Monkeypox vaccines are FREE. Your health care provider must give you the vaccine regardless of your ability to pay the administration fee.   

l Notes for DY 2 to 8 (PDF) Core Quality Withhold Technical Notes for DY 2 to 10 (PDF) Riverside University Health System - Health Advisory Public Health Advisory - Respiratory Viruses (PDF) A Message From IEHP Medical Director, Dr. Takashi Wada The 2022-2023 influenza season continues to coincide with circulation of COVID-19 virus (SARS-CoV-2). As of August 2022, approximately 94.2 million cases of COVID-19 had been reported in the United States. Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness, which helps decrease the stress on the U.S. health care system. IEHP DualChoice members who are 18 years of age or older may obtain flu vaccines through the IEHP Pharmacy Vaccine Network. Vaccine Notice: Access to Pharmacy Vaccine Network (PDF) Mpox Vaccination Locations San Bernardino County: Monkeypox (mpox) – Department of Public Health Riverside County: Mpox Vaccine Locations – Riverside University Health System Please advise members to call before going in for a vaccination as some locations are only available with appointments. Members may make appointments for the JYNNEOS vaccine at https://myturn.ca.gov/. Mpox Testing As of December 8, 2022, no commercial testing is available for the diagnosis of Mpox. Providers may contact CDC in the diagnosis, management of patients with suspected Mpox, and for any additional information regarding Mpox connect with the CDC Emergency Operations Center. Phone: 1-770-488-7100, Monday through Friday, 8:00 AM to 4:30 PM EST After Hours Phone: 1-404-639-2888 Treatment Mpox patients usually recover fully within 2-4 weeks without the need for medical treatment. While there are no treatments specifically for Mpox, the virus that causes Mpox is similar to the smallpox virus and therefore antiviral drugs developed to protect against smallpox may be used. The antiviral drug, tecovirimat (TPOXX), has been approved by the FDA to treat smallpox in adults and children. If you prescribe tecovirimat to treat members with Mpox the member must sign a consent form stating tecovirimat is an investigational drug that has not yet been approved by the FDA for treatment of Mpox. More information about tecovirimat visit https://www.cdc.gov/poxvirus/monkeypox/if-sick/treatment.html. Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations) What’s New for 2022-2023  By clicking on these links, you will be leaving the IEHP website. The composition of flu vaccines has been updated. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season. The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older. Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose. Preventive Services Immunizations  By clicking on these links, you will be leaving the IEHP website. CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do Immunization Timing 2022 (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.