Common use of HOOSIER HEALTHWISE SCOPE OF WORK Clause in Contracts

HOOSIER HEALTHWISE SCOPE OF WORK.  The toll-free numbers that the member can use to file a grievance or appeal by phone;  The fact that, if requested by the member and under certain circumstances: (1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and (2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member.  For a State hearing describe (i) the right to a hearing, (ii) the method for obtaining a hearing, and (iii) the rules that govern representation at the hearing.  Information about advance directives;  How to report a change in income, change in family size, etc.;  Information about the availability of the prior claims payment program for certain members and how to access the program administrator;  Information on alternative methods or formats of communication for visually and hearing-impaired and non-English speaking members and how members can access those methods or formats;  Information on how to contact the Enrollment Broker;  Statement that Contractor will provide information on the structure and operation of the health plan; and  In accordance with 42 CFR 438.10(f)(3), that upon request of the member, information on the Contractor’s provider incentive plans will be provided.

HOOSIER HEALTHWISE SCOPE OF WORK.  The toll-free numbers that the member can use to file a grievance or appeal by phone;  • The fact that, if requested by the member and under certain circumstances: (1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and (2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member.  ▪ For a State hearing describe (i) the right to a hearing, (ii) the method for obtaining a hearing, and (iii) the rules that govern representation at the hearing.  ▪ Information about advance directives;  ▪ How to report a change in income, change in family size, etc.;  ▪ Information about the availability of the prior claims payment program for certain members and how to access the program administrator;  ▪ Information on alternative methods or formats of communication for visually and hearing-impaired and non-English speaking members and how members can access those methods or formats;  ▪ Information on how to contact the Enrollment Broker;  ▪ Statement that Contractor will provide information on the structure and operation of the health plan; and  ▪ In accordance with 42 CFR 438.10(f)(3), that upon request of the member, information on the Contractor’s provider incentive plans will be provided.