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Search Results For : " UNIVERSITY OF BIRMINGHAMBIRMIN "

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Kids and Teens - Immunizations

s, and other diseases that can make them very sick or even cause death.  How do vaccines work? Vaccines train the body to fight germs that cause disease. When exposed to disease, the body will know how to fight and kill the germs before they cause health problems. This is called immunity against disease. Why so many vaccines? Vaccines are needed in all stages of life. Many are given to infants and young children who need them the most to Grow Well. Vaccines protect against diseases such as: Influenza (Flu) Measles, mumps, rubella Polio Tetanus Varicella (chicken pox) Pertussis (whooping cough) For a complete list of shots, see the Recommended Immunization Schedule for Persons Aged 0-18 (PDF) and Immunization Brochure (PDF). Get Vaccinated at No Cost to You With IEHP, you can get vaccinated at no cost. You can also find schedules for your shots and checkups in your IEHP Member Handbook. Ask your Doctor for an Immunization Record Card or print one by logging into your IEHP Health Account and bring it with you to each checkup.  

Community Resource Centers - FAQ

nters provide healthcare information, health education, fitness classes, and local resources to IEHP Members and the community. Our friendly bilingual staff are here to help you sign up for free classes, provide information on health benefits, learn about the health care system, and other local resources. We are conveniently located in Riverside, San Bernardino, and Victorville.  Free services to everyone Walk-ins are welcome Interactive activities  2. What types of classes do you offer ? Fitness Classes: Stay active with Yoga, Zumba (all levels), Tai Chi, Line Dance, Yoga for Seniors & People with Disabilities, Meditation, Aerobic Box, Latin Dance, Strength and Conditioning and Kid fitness. Wellness Classes: Learn about topics like nutrition, healthy cooking, gardening, managing asthma symptoms, controlling diabetes, stress management, and classes for teens and kids too. Virtual classes: Enjoy fitness, learn about your health, and have fun with the whole family all from the comfort of your home.  3. What types of services do you offer?  Assistance with benefits, Medi-Cal application process, health coverage, behavioral health services, local food pantries, job aid, transportation services, and much more.  4. How can I find resources online?  IEHP Members and non-members can search for free or reduced cost services like medical care, food, job training, and more at www.connectie.org. 5. How can I connect to virtual classes?   Click here to view the latest calendar.  6. If I’m not an IEHP Member, can I still join the classes? Yes! everyone is welcome. IEHP Members and non-members can participate in in-person or virtual classes. There are a few classes that are for IEHP Members only (see calendar for details).  7. Is there a fee to be part of the CRC or attend classes? All classes are absolutely FREE! 8. Do I need to register for a class and what are the requirements? There is no need to register. All classes are first come first serve, unless otherwise noted that pre-registration is required (see calendar for details). 9. How old do you have to be to participate in classes? Classes vary by age group. We offer children’s programs throughout the month (ages 0-5 and 4-11 with parents). In general, the fitness and health classes are for ages 12 and older, unless noted. Anyone under 18 years old (without a waiver signed by a parent/guardian*) must have an adult with them at all times. See the calendar for more details. *CRC Victorville location only 10. Do you have a daycare onsite? No. If you have any questions regarding children’s programming, please feel free to call and ask us at 1-866-228-4347. 11. Do I have to bring my own fitness equipment (yoga mats, etc.)? No. We offer classes that require little to no fitness equipment.  12. Is there a limit on how many classes I can take? There is no limit.  13. Can I be seen by a doctor at the CRC? No. However, our friendly and bilingual staff will assist you in finding a doctor if needed. Please 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. 14. Do you offer classes for seniors and people with disabilities?  Yes. We offer classes including but not limited to, Meditation, Yoga for Seniors and people with Disabilities, and Low-Impact Zumba Gold.        

Helpful Information and Resources - Texting Program FAQ

to view or change your doctor.  If you have a smartphone, you can download the IEHP Smart Care App in either Google Play or the App Store. You 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. Watch this video to learn more. How do I find a Doctor, Urgent Care or Behavioral Health Provider? To find a list of providers in your area please visit https://search.iehp.org/. How do I make or change a doctor’s appointment? Please call your Doctor’s office to make/change an appointment. Your Doctor’s phone number is listed on your IEHP Member Card.  How do I make an appointment with an eye doctor? For vision services, please call your Optometrist (Eye Doctor).  Need to find an eye doctor?  Click here https://search.iehp.org/ How do I print my IEHP Member Card or check my eligibility? You can login to the IEHP Member Portal to order (and print) your IEHP Member Card and check your eligibility.  If you have a smartphone, you can download the IEHP Smart Care App in either Google Play or the App Store. You can also call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm, Monday-Friday. TTY users should call 1-800-718-4347. Watch this video to learn more. How do I get more information on my Dental coverage? For dental coverage questions, please call Denti-Cal (dental program for Medi-Cal enrollees) at 1-800-322-6384 or visit https://dental.dhcs.ca.gov/ How do I change my address, phone or other contact information? You can login to the IEHP Member Portal to update your address or phone number.  If you have a smartphone, you can download the IEHP Smart Care App in either either Google Play or the App Store. You can also call IEHP Member Services at 1-800-440-IEHP (4347), 8am-5pm, Monday-Friday. TTY users should call 1-800-718-4347. You should also contact your County Medi-Cal office to update your address or phone number.  To report changes in Riverside County, call 1-877-410-8827 and in San Bernardino County, call 1-877-410-8829. Watch this video to learn more. How do I get information on enrollment in IEHP? You can contact our Enrollment Advisors at 1-866-294-4347 (or 1-800-720-4347 for TTY users), Monday-Friday, 8am-5pm.  How can I cancel my benefits with IEHP? 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. I am no longer an IEHP Member, how can I unsubscribe from the texting program?  Reply STOP at any time or text back STOP to 90902.  I am not a Member of IEHP, how can I cancel future messages? Reply STOP at any time or text back STOP to 90902.  I am receiving text messages in Spanish and I only speak English. Can I change my language? To receive future messages in English, reply back “English” to any of our messages.  I am receiving text messages in English and I only speak Spanish. Can I change my language? To receive messages in Spanish, reply back “Spanish” to any of our messages. Does IEHP offer transportation? For information about your transportation benefit, please refer to your Member handbook.  Medi-Cal Member Handbook IEHP DualChoice Member Handbook How do I obtain status on my prescription?  For information on your prescription, please call your pharmacy. If you have a question about your medicine, please talk to your Doctor.  How do I find a nearby pharmacy? For DualChoice Members click here.  For Medi-Cal Members click here.

Weight Management - Weight Management

ur health goals. Eat Healthy, Be Active Class A class for Members who want to learn how to eat healthy and be active. Members will learn about reading food labels, meal planning, and making healthier choices. Format: Group Duration: 4 weeks (2 hours per week) Ages: Any age (anyone under 18 years old must be accompanied by parent or guardian)  Call IEHP Health Education Department at 1-866-224-IEHP (4347) or 1-800-718-4347 for TTY users to sign up.  Diabetes Prevention Program (DPP) - Live the Life You Love Format: Online (small group) Duration: One 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. 

Helpful Information and Resources - IEHP Voice ID

HP!   In early 2022, IEHP launched an innovative technology called IEHP Voice ID. This voice recognition system uses your voiceprints to identify you.  Your speech tones can be stored in safe databases and later used to identify your unique voice—like fingerprints or facial scans.  How will I benefit from using IEHP Voice ID?  By opting in to IEHP Voice ID, you can save the time it would take to go through the series of questions to prove your identity. Each Member who uses IEHP Voice ID could cut the time to verify their identity from 3 minutes to less than 30 seconds! Using IEHP Voice ID streamlines each call—our Member Services representatives will know right away that they are talking to the right member.  Is it safe?  IEHP Voice ID is more secure than passwords, PINS, security questions, and older forms of security. The IEHP Voice ID system will send an alert if it finds copied speech or a recorded voiceprint. Voice biometrics experts say that a voiceprint is safer. It includes more than 100 unique behavioral traits of each person, such as accent, pitch, length of the vocal tract, and so on. How can I sign up for IEHP Voice ID? IEHP Members can 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 to sign up for IEHP Voice ID. The use of this service is optional. It does not cost you anything to sign up. 

Helpful Information and Resources - Interpreter Service

t Doctor visit? IEHP offers language interpreter services to all IEHP Members - and it's free! We will send an interpreter to your Doctor's office, so you'll have someone there who knows your language. We schedule interpreters for most any language, including American Sign Language. To schedule a language interpreter, call IEHP Member Services at least 5 days before your Doctor visit. To cancel your request, call at least 2 days before your Doctor visit.  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.

Medi-Cal Rx Transition

he pharmacy benefit for IEHP Members. Prescription medications for IEHP Members will be covered by “Medi-Cal Rx”. Bring both your Medi-Cal ID Card and IEHP ID card to the pharmacy when you pick up your prescriptions to avoid delays.  What is changing with my pharmacy benefit? Starting on January 1, 2022, you will get your Medi-Cal covered prescriptions through Medi-Cal Rx instead of IEHP. DHCS is working with a new contractor, Magellan Medicaid Administration, Inc. to provide pharmacy services. Will the cost of my medicines change? There will be no change in how you pay for your medicines. What do I need to do? Most people do not need to do anything. Your Doctors are being notified about the change. Will I need to change my medicines? Most people will not have to change their medicines. You will need to check the list of medicines covered by Magellan. The list of drugs that require prior approval may be different than the list IEHP uses. Your Doctor may need to get approval to refill prescriptions. He or she may talk to you about changing to a medicine that does not require prior approval. Will my pharmacy change? Most pharmacies will accept your new coverage. You can call the Medi-Cal Member Help Line (1-800-541-5555, TTY 1-800-430-7077) to ask if your pharmacy will accept Medi-Cal Rx. If your pharmacy does not work with Medi-Cal Rx, you may need to choose another pharmacy. What if I need help finding a pharmacy? The Medi-Cal Rx Pharmacy Locator online at www.Medi-CalRx.dhcs.ca.gov will be available in December 2021. Or starting on January 1, 2022, you can call Customer Service at 1-800-977-2273 24 hours a day, seven days a week or 711 for TTY Monday thru Friday, 8am to 5pm. What happens now? You will receive a new IEHP Member Card with the Magellan phone number. Always bring your IEHP Member Card and your Medi-Cal Benefits Identification Card (BIC) with you to your pharmacy. What if I have more questions? On or Before December 31, 2021 If you have questions about this notice or have Medi-Cal Rx general questions, contact the Medi-Cal Member Help Line (1- 800-541-5555, TTY 1-800-430- 7077), Monday thru Friday, 8am to 5pm.  On or After January 1, 2022 You can call the Medi-Cal Rx Call Center Line (1-800-977-2273) 24 hours a day, seven days a week, or 711 for TTY, Monday thru Friday, 8am to 5pm. What happens if I have a complaint? Magellan will accept and resolve your complaint. You can submit a complaint either in writing or by telephone. You can only use this website and phone number to file a complaint on or after January 1, 2022. Visit www.Medi-CalRx.dhcs.ca.gov or call Customer Service at 1-800-977-2273. Can I still call IEHP for help with my pharmacy complaints? IEHP will no longer handle complaints for pharmacy services received on or after January 1, 2022. How does the change affect Members with Kaiser Permanente? Members with Kaiser Permanente can still get prescriptions through\ Kaiser-affiliated pharmacies.

MediCal Long-Term Services and Supports

le Members to help them live independently in the community. You may qualify for the LTSS services listed below. In-Home Supportive Services (IHSS) If you have a disability, are blind, or over 65 years old and not able to live in your home without help, you may qualify. Get help around the house and other daily care needs. With IHSS, you find your own caregivers to help with: Cooking meals and cleaning up Personal care services (such as bowel and bladder care, bathing, and grooming) Laundry and household cleaning, grocery shopping and errands, rides to Doctors visits To learn more about IHSS: San Bernardino County In-Home Supportive Services (877) 800-4544 (909) 252-4703 TTY, Monday-Friday, from 8am – 5pm Riverside County In-Home Supportive Services  (888) 960-4477 (TTY 711), Monday - Friday, from 8am – 5pm Multipurpose Senior Services Program (MSSP) MSSP is a case management program that provides Home and Community-Based Services to Medi-Cal eligible individuals. To be eligible, you must be 65 years of age or older, live within a site’s service area, be able to be served with MSSP’s cost limitations, be appropriate for care management services, currently eligible for Medi-Cal, and certified or certifiable for placement in a nursing facility. Services include: Adult day care/support center Housing assistance Chore and personal care assistance Protective supervision Care management Respite Transportation Meal Services Social Services This benefit is covered up to $4,285 per year. To learn more about MSSP: San Bernardino County Multipurpose Senior Services Program (877) 565-2020, 24-Hour Hotline (909) 891-3900 TTY, Monday-Friday, from 8am – 5pm Riverside County Multipurpose Senior Services Program (800) 510-2020 (951) 867-3800 (951) 697-4699 TTY, Monday-Friday, 8am – 5pm Community Based Adult Services (CBAS) CBAS is an outpatient, facility-based service program where people attend based on a schedule. It offers skilled nursing care, social services, therapies (including occupational, physical, and speech), personal care, family/caregiver training and support, nutrition services, transportation, and other services. We will pay for CBAS if you meet the eligibility criteria. Learn about Community Based Adult Services (PDF) Nursing Facility (NF) A NF is a place that provides care for people who cannot get care at home but who do not need to be in a hospital. Nursing care Care management Bed and board (daily meals) X-ray and laboratory Physical, speech and occupational therapy Drugs given to you as part of your plan of care.  To learn more about these programs, 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, and ask for the Long-Term Services and Supports (LTSS) Unit.  Learn how IEHP helps Members transition back home (PDF) Here is placed a youtube LTSS Custodial Transitions Video Caregiver Resources in the Inland Empire By clicking on any of the links below, you will be leaving the IEHP website.  Inland Caregiver Resource Center 1430 E Cooley Dr. Colton, CA 92324 (909) 514-1404 https://www.inlandcaregivers.com      Services: Information and referral, family consultation, support groups, short-term counseling, educational workshops, respite and supplemental services. Alzheimer’s Greater Los Angeles  002 Iowa Ave, Suite 1072 Riverside, CA 92509 (909) 944-9146 https://www.alzgla.org      Services: information and referral, 24/7 Hotline, Care Counselors, Early Stage Services, Memory Mornings, Support Groups, Community Education, and Advocacy. Senior Companions 600 West Fifth St. San Bernardino, CA 92410 (909) 384-5413 http://www.sbcity.org/cityhall/parks/senior_services/default.asp#SCP Senior Companions provide support to family caregivers. They assist with grocery shopping, transportation to medical appointments, meal preparation, encouraging clients to participate in daily activities, reminiscing, providing companionship and love. San Bernardino County Department of Aging and Adult Services 686 E. Mill St. San Bernardino, CA 92415 (909) 891-3900 http://hss.sbcounty.gov/daas/Default.aspx Services: Adult Protective Services, Family Caregiver Support, Long-Term Care Ombudsmen, Nutrition Services, Senior Employment Program, Information and Assistance Riverside County Office on Aging 6296 River Crest Dr., Suite K Riverside, CA 92507-0738 (951) 867-3800 https://www.rcaging.org Services: Care Coordination, Caregiving Resources, Care Transitions Intervention (CTI), Elder Abuse Education, Health Insurance Counseling and Advocacy Program (HICAP), Fit After 50,  Grandparents Raising Grandchildren, Health Promotion, Legal Assistance, Nutrition, Senior Employment, Volunteer Services   Community Access Center 6848 Magnolia Avenue, Suite 150 Riverside, CA, 92506 (951) 274-0358 http://www.ilcac.org/ Services: supportive services and independent living skills training. Rolling Start 1955 S. Hunt Street, Suite 101 San Bernardino, CA 92408 (909) 890-9516 http://www.rollingstart.com Services: disability information and referral, housing, independent living skills training, assistive technology, and advocacy. Alzheimer’s Association Ontario Office 3200 Inland Empire Blvd., Suite 280 Ontario, CA 91764 (909) 406-5376 https://alz.org/socal/about_us/our_regional_offices Palm Desert Office 74020 Alessandro Dr., Suite A Palm Desert, CA 92260 (760) 996-0006 https://alz.org/socal/about_us/our_regional_offices You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download a free copy by clicking Adobe Acrobat Reader.  

Medi-Cal Rights and Responsibilities

ghts: To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical records. To be given information about the plan and its services, including Covered Services, Practitioners, Providers, and Member rights and responsibilities. To be able to choose a PCP within IEHP’s network. To take part in decisions about your health care, including the right to refuse treatment. To voice grievances, verbally or in writing, about the organization or the care given. To provide feedback about the organization’s Member rights and responsibilities policies. To get care coordination. To request an appeal of decisions to deny, defer or limit services or benefits. To get oral interpretation services for their language. To get free legal help at your local legal aid office or other groups. To create advance directives. To have access to family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to federal law. To request a State Hearing, including instructions on how an expedited hearing is possible. To have access to, and where legal and appropriate, get copies of, amend or correct your Medical Record. To disenroll upon request. Members who can request expedited disenrollment include, but are not limited to, those getting services under the Foster Care or Adoption Assistance Programs and those with special health care needs. To access Minor Consent Services. To get written Member-informing materials in other formats (such as braille, large-size print and audio) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions Code Section 14182 (b)(12). To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. To learn about and discuss available treatment options and alternatives with regard to cost or benefit coverage, presented in a manner appropriate to your condition and ability to understand. To get a copy of your medical records, and request amendments or corrections, as specified in 45 Code of Federal Regulations §164.524 and 164.526. To freely exercise these rights without adversely affecting how you are treated by IEHP, Providers or the State. To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Service Facilities, midwifery services, Rural Health Centers, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to the federal law. If you have been getting care from a health care provider, you may have a right to keep him or her for a certain time period. Please contact IEHP Member Services, and if you have more questions, please contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll-free number, 1-888-466-2219 (TTY) 1-877-688-9891, or online at https://www.dmhc.ca.gov/. As a Member of IEHP, you are responsible to: Be familiar with and ask questions about your health plan options, your health plan coverage limitations and exclusions, rules about the use of network providers, coverage and exclusions, rules, appropriate process to obtain information and process to appeal coverage decisions. If you have a question about your coverage, 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. Follow the advice and care procedures requested by your Doctor and IEHP. If you have a question about these procedures, 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. Request interpreter services at least 5 working days before a scheduled appointment. Call your Doctor or pharmacy at least 3 days before you run out of medicine. Cooperate with your Doctor and staff and treat them and other patients with respect. This includes being on time for your visits or calling your Doctor if you need to cancel or set up a new appointment. Understand that your Doctor’s office may have limited seating for patients and caregivers only. Give accurate data to IEHP, your Doctor, and any other provider. This helps you get better care. Understand your health care needs and be part of your health care decisions. Ask your Doctor questions if you do not understand. Work with your Doctor to make plans for your health care. Follow the plans and instructions for care that you have agreed on with your Doctor. Notify IEHP and your Doctor if you want to stop the plans and instructions you have agreed on or no longer want to participate in health management programs. Immunize your children by age 2 years and always keep your children’s vaccines up to date. Call your Doctor when you need routine or urgent health care. Care for your own health. Live an active life, exercise, have a good diet, and don’t smoke. Avoid knowingly spreading disease to others. Use IEHP’s grievance process to file a complaint. 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 to file a complaint (grievance or appeal). Report any fraud, waste or abuse to IEHP by calling the Compliance Hotline at (866) 355-9038 or the proper authorities. Understand that there are risks in getting health care and limits to what can be done for you medically. Understand that it is a health care provider’s duty to be efficient and fair in caring for you as well as other patients.

Coronavirus

ur top priority. We’ll continue to update this web page with the latest information and instruction regarding Coronavirus (COVID-19). Announcements 5/02/22: The FDA extended the expiration dates for a number of antigen over-the-counter COVID-19 test kits. Watch this video to learn more. 2/15/21: Effective February 16, 2022, the state of California will no longer require vaccinated people to wear masks indoors in public places. Unvaccinated people are still required to wear masks indoors. Masking indoors will only be “strongly recommended” by the State for those who are vaccinated. Click here to learn more. 2/4/21: On January 31, 2022, the Food and Drug Administration (FDA) approved the second COVID-19 vaccine - Moderna’s Spikevax vaccine (widely known as the Moderna vaccine). The Spikevax vaccine, is now approved for use in people ages 18 and older. Click here to learn more. 1/19/21: 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. 1/07/21: The recent rise of the Omicron variant further stresses the importance of COVID vaccines, boosters, and preventive efforts (use of masks) are needed to protect against COVID-19. Schedule your vaccine today: www.myturn.ca.gov 1/06/21: The Centers for Disease Control and Prevention expands booster shot eligibility for 12–17-year-olds. Click here to learn more.  10/29/21: The Food and Drug Administration authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 through 11 years of age. Click the link to make an appointment. https://myturn.ca.gov/ 9/23/21: The Food and Drug Administration (FDA) authorizes a booster shot of Pfizer BioNTech COVID vaccine for the following populations: people 65 years of age or older, people 18-64 years of age at high risk of severe COVID-19, and people 18-64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19. Click here to learn more. 8/17/21: The FDA amended the emergency use of Pfizer and Moderna COVID-19 vaccine to allow an additional dose to be given to people with moderately to severely compromised immune systems after the initial 2-dose series. Click here to learn more. 8/17/21: The CDC recommends the COVID-19 vaccine for people who are pregnant, breastfeeding, trying to get pregnant or may become pregnant in the future. Unvaccinated women who are pregnant or were recently pregnant are more likely to get severely ill with COVID-19 compared with non-pregnant women. Click here to learn more.   8/06/21: Nearly all COVID deaths in the US are now among the unvaccinated. Protect yourself from the new surge in our region. Get vaccinated. Click here to make an appointment. 5/20/21: On June 15th, fully vaccinated Californians can go mask-free in most indoor settings. Click here for more information. 5/20/21: San Bernardino County urges residents to get vaccinated for COVID-19. Walk-ups are now allowed at all County-operated sites and many  private-run sites.  Getting protected could not be easier. Click here for more information. 5/13/21: The Pfizer COVID-19 vaccine is now available for children ages 12-15. Click here to make an appointment. 4/26/21: Riverside County reinstates the use of the Johnson and Johnson vaccine. Click here to learn more. 4/16/21: Riverside and San Bernardino County temporarily pause the use of the Johnson & Johnson COVID-19 vaccine in accordance with recommendations made by state and federal health agencies. Click here to learn more.  4/7/21: San Bernardino County residents ages 16+ are now eligible to get the COVID-19 vaccine. Click here to make an appointment. 4/6/21: Riverside County residents ages 16+ are now eligible to get the COVID-19 vaccine. Click here to make an appointment. 4/1/21: Omnitrans is offering San Bernardino county residents two FREE shuttle services to those with COVID-19 vaccine appointments in Ontario and San Bernardino. Click here for more information. 3/29/21: Starting April 1st, Riverside and San Bernardino County residents 50+ can get the COVID-19 vaccine and on April 15th all residents 16+ can get the vaccine. To make appointment, click on your county below. Riverside county San Bernardino county 3/29/21: San Bernardino County residents who accompany an eligible family member to an appointment are now eligible to receive the COVID-19 vaccine, even if they don’t fall into an eligible category. Residents must have an appointment at the same location and at approximately the same time as their eligible family member. Click here to make an appointment. 3/19/21: San Bernardino County residents that are high risk or disabled do not need to show proof of eligibility to get the COVID-19 vaccine. Residents will only be asked to self-attest to their eligibility. Click here to learn more. 3/12/21: Starting next week, San Bernardino County residents ages 16-64 with underlying medical conditions and/or a disability will be eligible for the COVID-19 vaccine. Click here to learn more.  3/10/21: The Centers for Disease Control and Prevention (CDC) has issued new guidance that allows people who are fully vaccinated to gather with each other without wearing masks. Click here to learn more. 3/03/21: San Bernardino County opens COVID vaccine appointments for food and agriculture workers. Click here to learn more. 2/26/21: To support COVID-19 vaccination efforts, IEHP partnered with San Bernardino County to open a new vaccine site at our headquarters in Rancho Cucamonga. Appointments are required and can be made at SBCovid19.com/vaccine. 2/17/21: San Bernardino County announces additional vaccine sites for seniors 65+ interested in getting the COVID-19 vaccine. Click here for more information. 2/10/21: San Bernardino County residents 65+ are urged to sign up to be notified when new COVID-19 vaccine appointments become available. Click here to sign up.  2/1/21: Riverside County residents who received their first dose of the COVID-19 vaccine at a county clinic will be contacted by the county health officials to schedule their second dose. Click here to learn more.  1/29/21: Riverside County has appointments available for residents 85+ who are interested in getting the COVID-19 vaccine. Click here to view available appointments. 1/25/21: California has lifted the regional stay-at-home orders issued in December, moving San Bernardino and Riverside County back into the purple tier. Residents are urged to continue safe practices, avoiding crowds, and wearing a mask when leaving home. In addition, increased testing will help the counties move into the next level of the state’s reopening plan.    1/22/21: Riverside County will open appointments Saturday, January 23rd for the upcoming COVID-19 vaccine clinics. Click here to register. 1/15/21: San Bernardino County residents ages 65 and over are now eligible for the COVID-19 vaccine. Click here for vaccine locations and registration. 1/14/21: Riverside county residents 65 and over can now get vaccinated for COVID-19 at various locations throughout the county. Click here for more information. Click here to view additional announcements Local Resources San Bernardino County 2-1-1 San Bernardino County Wic Riverside County Wic

Resources for the Uninsured

y for healthcare coverage through Medi-Cal, Covered California, or for county-based programs. Apply for health coverage through Medi-Cal and choose IEHP, your Inland Empire Health Plan. Get quality medical, behavioral health and wellness services and no cost.  What is Medi-Cal? Medi-Cal is a no-cost or low-cost health coverage program. It provides health, dental and vision coverage to qualified low-income California residents. How do I apply for Medi-Cal: Apply for no-cost health coverage right over the phone. Call the IEHP Enrollment Advisors at (866) 294-4347, Monday – Friday, 8am – 5pm. TTY users should call (800) 720-4347.  You may also call Health Care Options at 1-800-430-4263 or visit or visit www.healthcareoptions.dhcs.ca.gov. TTY users should call 1-800-430-7077. Click here to learn more. What is Covered California? Covered California is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well-known companies.  Click here to learn more.https://www.coveredca.com/ County Health Clinics If you are uninsured and do not qualify for IEHP you can find free/low cost health clinics and prescription drug assistance programs in Riverside and San Bernardino counties with our Healthcare Connections PDFs:  San Bernardino (PDF) Riverside (PDF) How can I find resources in my community? IEHP Community Resource Centers The IEHP Community Resource Centers (CRC) are your local resource for healthcare information in Riverside, San Bernardino and Victorville. Our bilingual staff can help you to take free classes, learn about health care & learn about health coverage. Click here to learn more. Connect IE Connect IE is a new one-stop, interactive website that makes it easy to link people to community resources in the Inland Empire. By clicking on the link below you will be leaving the IEHP site. Visit ConnectIE to find out more! Resources for the undocumented Public Charge Information The ABC's of Public Charge You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader.

Kids and Teens - Kids Health

Group Duration: 30-minute session Ages: 0-5 years old, must be accompanied by parent or guardian These classes are designed for families with infants, toddlers and children ages 0-5.  The classes promotes healthy development and parenting skills using engaging play and social interaction. Parents are encouraged to access health care resources and work with their pediatricians on developmental screening as well as early intervention. Learn about health literacy including essential topics such as well-baby visits, feeding, language development, safety, physical activity and immunizations. Developmental screenings are available upon request.   Click here to check out the Circle Time schedule and register. To request developmental screening for your child email us at screening@iehp.org See also: By clicking on the links below, you will be leaving the IEHP site. Developmental Milestones Well Baby Visit Schedule Immunization Schedule Well Child Journey (PDF)  

Join Our Network - Provider Network Expansion Fund

is to support the hiring of PCPs, Specialists, and Midlevel Practitioners that will serve the Medi-Cal population in the Inland Empire. Entities that hire qualified candidates are eligible to receive a subsidy up to $75,000 for Midlevel Practitioners, $100,000 for PCPs, and $150,000 for Specialists. All candidates must be a new access point in IEHP's network and not have prior history in the Inland Empire. Please take note of two significant changes made to the program: The NEF Program will be targeting specific Provider types. The Provider types and corresponding regions displayed below comprise the list of positions that are currently eligible to receive a subsidy through the NEF Program.   The funding disbursement schedule has been revised as follows:  50% when the qualified candidate completes credentialing 25% when the candidate completes six (6) months of service 25% when the candidate completes one (1) year of service Entities that are interested in receiving support through the NEF Program must submit a complete application to be considered for the funding opportunity. Completed applications should be e-mailed to Kathryn Yurcak at Yurcak-K@iehp.org  and Tiffany Pham at Pham-T2@iehp.org. For any questions regarding this program, please contact Kathryn Yurcak, Business Analyst at Yurcak-K@iehp.org or Tiffany Pham, Business Analyst at Pham-T2@iehp.org. Program Description (PDF) NEF Application (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. Corona/Temecula/Hemet Cardiac/Thoracic Surgery Cardiology Family Practice General Surgery Genetics Internal Medicine OB/GYN Pain Management Pediatrics Plastic Surgery Psychiatry Surgery Urology   High Desert Allergy and Immunology Cardiac/Thoracic Surgery Cardiology Dermatology Family Practice General Surgery Genetics Internal Medicine Neurology Neurosurgery OB/GYN Otolaryngology Pain Management Pediatric Subspecialties Pediatric Surgery Pediatrics Podiatry Psychiatry Psychology Rheumatology Surgery Urology   Low Desert Allergy and Immunology Cardiology Family Practice General Surgery Internal Medicine OB/GYN Pain Management Pediatric Surgery Pediatrics Psychiatry Pulmonary Medicine Urology   Riverside Allergy and Immunology Dermatology Family Practice General Surgery Genetics Internal Medicine OB/GYN Pain Management Pediatrics Psychiatry Surgery Urology   San Bernardino Proper Dermatology Family Practice Genetics Internal Medicine OB/GYN Pain Management Pediatric Surgery Pediatrics Psychiatry   West San Bernardino Family Practice Genetics Internal Medicine Neurology OB/GYN Pediatric Surgery Pediatrics Plastic Surgery Psychiatry Surgery      

Join Our Network - PCP & Specialists

HP) directly contracted provider. Prior to extending a contract, we must receive the following documents. Please completely fill out all required documents. Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you. New Contract Existing Contract (Adding New Provider) Physician Network Form (PDF) Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program) Physicians and Specialists (PDF) (M.D., D.O., D.P.M., D.C., O.D., S.P., AuD., P.T., etc) Pre-Contractual Letter (PDF) (Only applies to PCPs. Please review and return signed if all outlined criteria is met) Mid Level Practitioners (PDF) (P.A., N.P., and C.N.M.) Supervisor Agreement (PDF) (Only Applies to Physician Assistants) Medical-Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program) All documents should be e-mailed to contract@iehp.org. All documents should be e-mailed to contract@iehp.org. Provider Maintenance Request Form (PCP, OB/GYN, and Mid-Levels ONLY) can be found here (PDF). Contracts Maintenance Request Form (Specialists ONLY) can be found here (PDF). Individual W-9 form can be found here (PDF). Direct Deposit Frequently Asked Questions can be found here (PDF). National Plan & Provider Enumeration System (NPPES) Portal login: https://nppes.cms.hhs.gov/#/. NPI Address Update Instructions can be found here (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.

Join Our Network - Vision

contracted provider. Prior to extending a contract, we must receive the following documents.  PLEASE NOTE, IEHP is only accepting Vision Providers who meet the following exceptions through October 31, 2022: Providers practicing in any of the CalAIM service area expansion territories effective January 1, 2022 (including formerly voluntary and excluded zip codes) Providers filling positions that have been vacated in an existing practice Providers transitioning from an existing group agreement to their own individual agreement Providers being added to existing Vision groups Please completely fill out all required documents and submit to contract@iehp.org. Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you.  1. Vision Provider Network Participation Form (PDF) 2. Letter of Interest that outlines the following: What Specialty/Services you are interested in contracting for Facility locations(s) National Provider Identifier (NPI) for each facility Medi-Cal Provider information number (PIN) 3. W-9 Form (PDF) A current Taxpayer Identification Number and Certification Form 4. California Participating Physician Application (PDF) 5. Liability Insurance Certificate Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrance; and Three Million Dollars ($3,000,000) aggregate per year for professional liability 6. Facility Business License - Faculty 7. Ownership Information (PDF) Name, Title, and Percent of Ownership Contracts Maintenance Request Form can be found here (PDF). All documents should be e-mailed to contract@iehp.org. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Plan Updates - Medicare Beneficiary Identifier (MBI)

d Services (CMS) to remove Social Security Numbers (SSN) from all Medicare cards to address the risk of Medicare beneficiary medical identity theft. CMS will mail out new Medicare Cards to Medicare Beneficiaries starting April 2018 through April 2019.  By clicking on the CMS web links below, you will be leaving the IEHP website. For more information regarding the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.html. For an overview of the new Medicare cards, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home. New Medicare card resources: New Medicare Card: Information for Partners & Stakeholders (PPT) You're getting a new Medicare card! (PDF) New Card! New Number! (PDF) "10 Things to Know About Your New Medicare Card" (PDF) Your New Medicare Card: Information for People with Medicare (PPT) For additional resources regarding the new Medicare cards, please visit https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-Employers.html. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Pharmacy Services - Drug MAC

rug list and addresses MAC appeals for IEHP’s Medicare Line of Business.  Please direct all MAC appeals, regardless of fill date, via email to m5@dsthealth.com; or direct MAC appeals over the phone to DST Pharmacy Solutions at 1-800-522-7487, Monday through Friday, 8:00AM – 5:00PM CST (6:00AM – 3:00PM PST). Click here for more information about previous IEHP MAC Drug Lists and MAC appeals processing. Information on this page is current as of December 20, 2021

COVID-19 - COVID-19 Vaccine

c9; border: none; color: white !important; padding: 15px 32px; border-radius: 25px; display: inline-block; text-align: center; cursor: pointer; } COVID-19 Vaccines: Latest news and updates The COVID-19 vaccines are safe, effective and free for all IEHP Members. Recommended for everyone ages 5 and older, the vaccines can help protect people from severe illness, hospitalization and death due to COVID-19. The vaccines won’t make people sick or give them COVID-19. They may have some minor side effects, which are not harmful and should last no more than a few days. The vaccines can help us end the pandemic and save lives. Vaccinated people should keep wearing a mask, washing their hands often and maintaining at least 6 feet of distance in public places. IEHP Members can learn more by continuing to visit the IEHP website and or visiting the California Department of Health’s website. CLICK HERE TO FIND A VACCINE CLINIC NEAR YOU How vaccines build immunity While the COVID-19 vaccines are relatively new - the technology and science behind the vaccines have been in development for decades. In the video below, we demonstrate how years of vaccine research and advanced technology allowed researchers and scientists worldwide to be prepared to develop an mRNA vaccine that could help fight the spread of a global infectious disease. PFIZER VACCINE GETS FULL FDA APPROVAL On August 23, 2021, the U.S. Food and Drug Administration (FDA) approved the first COVID-19 vaccine – the Pfizer-BioNTech COVID-19 Vaccine (widely known as the Pfizer vaccine). The approved vaccine will now be marketed as Comirnaty (koe-mir’-na-tee) for the prevention of COVID-19 disease in people 16 years of age and older. Effective October 29, 2021 the Pfizer vaccine is available under emergency use authorization, including for use by children aged 5 through 18 years of age and for the administration of a booster dose in certain immunocompromised people. Please note, the Pfizer vaccine and Comirnaty are the same vaccine. The FDA reports that they have the same formulation and are interchangeable.  Where can I get the vaccine? For Members who want the vaccine, there are several options: IEHP recommends My Turn online at myturn.ca.gov. My Turn online, a website from the California Department of Public Health, is a convenient, one-stop website where those who want a COVID-19 vaccine can: Set up their first, second and booster shot appointments Set up family or group appointments Find walk-in clinics in their area Set up in-home vaccinations (if needed) Arrange for transportation (if needed) For those without internet access, the California COVID-19 Hotline at 1-833-422-4255 can help provide the same services. Large pharmacy chains, like CVS and Walgreens provide the vaccine. Many have walk-in appointments available. IEHP recommends calling the pharmacy first to confirm. Vaccine appointment sign-ups are also available online through the public health department in your county. For Riverside County, visit www.ruhealth.org/covid-19-vaccine. For San Bernardino County, visit www.sbcovid19.com/vaccine/.  Do I have to pay for the vaccine? No. The vaccine is free for everyone who wants it.  Is the vaccine safe? Yes, the top medical experts in our nation and state agree that COVID-19 vaccines are safe and effective. The vaccines were tested in large clinical trials to make sure they meet safety standards. Many people from different ages, races, and ethnic groups, as well as those with different medical conditions, were part of the trials. Does the vaccine have side effects? Most people do not have serious problems after being vaccinated for COVID-19. Any minor symptoms that result usually go away on their own within a week. Call your Doctor immediately if you start to have any of the following symptoms: severe headache, abdominal pain, leg pain/swelling, or shortness of breath, chest pain, feelings of having a fast-beating, fluttering or pounding heart. Your Doctor or health care provider will explain any potential side effects and what you need to do about them.  Since the emergency use authorization of the Moderna and Pfizer-BioNTech COVID-19 vaccines, myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) have occurred in some people who have received these vaccines. In most of these people, symptoms began within a few days following the second dose of these vaccines. There have been confirmed reports of myocarditis or pericarditis in individuals who received COVID -19 vaccine, particularly among males ages 30 and younger. While this is concerning and is under further investigation, myocarditis or pericarditis after COVID vaccination is extremely rare as more than 318 million doses of COVID-19 vaccines have been administered in the United States from December 14, 2020 through June 21, 2021. Will there be any long-term side effects? COVID-19 vaccines are being tested in large clinical trials to assess their safety. It will take time and more people will need to get the vaccine before we learn about very rare or long-term side effects. The Food and Drug Administration (FDA) and the U.S. Centers for Disease Control (CDC) will continue to monitor the safety of COVID-19 vaccines. Health care providers are required to report any problems or adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS). What if I have side effects? Contact your Doctor right away. The CDC offers a smartphone-based tool called v-safe to check in on people’s health after they receive a COVID-19 vaccine. When you get your vaccine, you should also get a v-safe handout telling you how to enroll in the program. If you enroll, you will get regular text messages with links to surveys where you can report any problems or side effects after getting a COVID-19 vaccine. Can the vaccine give me COVID-19? No, the vaccine cannot give you COVID-19 because it does not contain an infectious virus. How many shots will be needed? The Pfizer and Moderna vaccines require two shots, 3 to 4 weeks apart. While the first shot helps build protection, you will need to come back a few weeks later for the second one to get the most protection the vaccine can offer. Your Doctor will advise you when you should return for the second shot, as it varies by type of vaccine. The J&J vaccine requires only one shot. Do I need the booster shot? Studies show after getting vaccinated against COVID-19, protection against the virus and the ability to prevent infection with variants may decrease over time and due to changes in variants. However, the booster shot may increase your immune response to COVID-19 and its variants, increasing prevention efforts against the virus. Who can get a booster shot? Booster shots are available to everyone ages 12 years and older who are fully vaccinated but the timing of the booster varies by vaccine and age group. When can I get the booster shot? If you received the Pfizer-BioNTech vaccine, everyone 12 years or older should get the booster at least five months after completing your primary COVID-19 vaccination series. If you received the Moderna vaccine, adults 18 years and older should get the booster at least six months after completing your primary COVID-19 vaccination series. If you received the Johnson & Johnson’s Janssen vaccine, adults 18 years and older should get the booster at least two months after receiving your J&J/Janssen COVID-19 vaccination. Does the booster shot have side effects? You may experience side effects after getting the booster shot. These are normal signs that your body is building protection against COVID-19. Do I need to keep wearing a mask and avoiding close contact with others once I get fully vaccinated? Yes. While experts learn more about the protection that COVID-19 vaccines provide, please keep using all the tools we know can help stop the spread of COVID-19. This means keep wearing a mask, washing your hands often, avoiding crowds, and maintaining at least 6 feet of distance in public places. Can children and babies get COVID-19? Yes. Children can get COVID-19. Most children with COVID-19 have mild symptoms, or they may have no symptoms at all, which is called being asymptomatic. Fewer children have been sick with COVID-19 compared to adults. But, infants (children younger than 1 year old) and children with certain medical conditions might have a higher risk for getting COVID-19. Can children get a COVID-19 vaccine? COVID-19 vaccines are approved for children 5 years old and older. To learn more, visit the CDC website and/or your county’s public health departments online:  Click here for San Bernardino County Click here for Riverside County Can I take the COVID-19 vaccine and the flu vaccine at the same time? Yes. The CDC has approved the use of routine vaccines for children, adolescents and adults (including pregnant women) on the same day as COVID-19 vaccines (as well as within 14 days of each other). Talk to your Doctor about what’s best for you. If I have previously tested positive for COVID-19, can I still get the vaccine? Yes. People are advised to get a COVID-19 vaccine even if they have been sick with COVID-19 before. This is because re-infection with COVID-19 is possible. Those who had a diagnosis in the past three months, be sure to talk to your Doctor about when you should get the vaccine. Will IEHP provide transportation to a COVID-19 vaccine clinic? Yes, IEHP will provide transportation to a COVID-19 vaccine clinic in the county where you live. How do I request transportation? Contact IEHP Transportation Call Center at 1-800-440-4347. Will the drive wait with me? No, the driver will not wait. Transportation will be provided as a roundtrip. You will need to contact the transportation provider to request a return pickup once you are ready. Can I take my family members? IEHP will provide transportation to an IEHP Member and one other passenger. How much time is needed to request transportation? IEHP will assist with transportation to the COVID-19 vaccine clinic in fewer than 5 business days. However, we cannot guarantee same-day requests. Where can I learn about COVID-19 and COVID-19 vaccines? IEHP Members can learn more by visiting the IEHP website or the California Department of Health’s website. Members can also learn more about COVID-19 at the California Coronavirus Response website or the CDC’s website

IEHP DualChoice - D-SNP Transition

IEHP DualChoice (HMO D-SNP) on January 1, 2023. Unless you change plans, IEHP DualChoice (HMO D-SNP) will provide your Medicare benefits. You will keep all of your Medicare and Medi-Cal benefits. You will not have a gap in your coverage. You will be automatically enrolled in IEHP DualChoice and do not need to do anything to keep these services. IEHP DualChoice is very similar to your current Cal MediConnect plan. With IEHP DualChoice, you will still have an IEHP DualChoice Member Service team to get help for your needs. You won’t pay a premium, or pay for doctor visits or other medical care if you go to a provider that works with our health plan. To learn more about your prescription drug costs, call IEHP DualChoice Member Services. To ask if your PCP or other providers are in our network in 2023, call IEHP DualChoice Member Services. Click here to learn more about IEHP DualChoice. What services will my Medicare Medi-Cal Plan cover? IEHP DualChoice will cover many of the Medicare and Medi-Cal benefits you get now, including: All Medicare covered services, doctors, hospitals, labs, and x-rays You will have access to a Provider network that includes many of the same Providers as your current plan Prescription drugs covered by Medicare Coordination of the services you get now or that you might need Transportation to medical services Medical supplies Durable Medical Equipment (DME) Nursing home care Community-Based Adult Services (CBAS) You will have access to a Provider network that includes many of the same Providers as your current plan. You will not have a gap in your coverage. You will be automatically enrolled in a Medicare Medi-Cal Plan offered by IEHP DualChoice. You don’t have to do anything if you want to join this plan. If you want to change plans, call IEHP DualChoice Member Services.  If you have questions, you can contact IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY: 1-800-718-4347.

IEHP DualChoice - Problems with Part D

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