For Members

Member materials

Getting to know your plan

As an MCC of AZ (HMO SNP) member, you need to know where to find information about your plan benefits, which providers and pharmacies to use, how to file appeals and grievances and more. These member materials will tell you everything you need to know.

2020 Materials:

Evidence of Coverage
List of Covered Drugs (Formulary)
LIS Rider
Summary of Benefits
Provider and Pharmacy Directory
Notice of Privacy Practices
LIS Premium Summary

2020 Star Ratings Notice

 

Important member information

Member rights and responsibilities

MCC of AZ (HMO SNP) members have the following rights:

  • To receive information about MCC of AZ (HMO SNP)’s services, practitioners and providers, enrollment, informational or instructional materials, grievance and appeal rights, and member rights and responsibilities annually in a manner appropriate to your condition and ability to understand
  • To receive reasonable accommodation if required
  • To be treated with respect and dignity and in recognition of your rights to privacy
  • To participate with practitioners in making decisions about your health care, including the right to refuse treatment
  • To participate in a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage
  • To voice complaints or appeals about the plan or the care provided
  • To make recommendations regarding your rights and responsibilities policy
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • To request and receive a copy of your medical record and request that the record be amended or corrected
  • To not be balanced billed by a provider for any service
  • To receive services in a culturally competent manner and nondiscriminatory manner
  • To receive updates and/or changes to the rights and responsibilities at least annually
  • To receive the Evidence of Coverage annually
  • To exercise your member rights without negative consequences

MCC of AZ (HMO SNP) members also have responsibilities, including the responsibility to:

  • To the extent possible, provide information that MCC of AZ (HMO SNP), our practitioners and providers need to appropriately care for you
  • Follow the agreed upon plans and instructions for care
  • Understand your health problems and participate in developing mutually agreed upon treatment goals and care plans
  • Get familiar with covered services and the rules that must be followed to get covered services
  • Inform us if you have any other health insurance coverage or prescription drug coverage in addition to this plan
  • Tell your doctor and other healthcare providers that you’re enrolled in MCC of AZ (HMO SNP)
  • Help doctors and other providers care for you by giving them information, asking questions and following through on the care plan
  • Be considerate by respecting the rights of other patients and acting in a way that is respectful to the practitioner, provider and staff
  • Pay any health care bills that are owed
  • Tell us if there is a change of residence
  • Call Member Services for help when you have questions or concerns
Disenrollment rights

Disenrollment means ending your membership in MCC of AZ (HMO SNP).

Ending your membership in our plan may be your own choice (voluntary) or not your choice (involuntary). For example, you may decide that you want to leave our plan. You can do this for any reason. There may also be situations where you are required to leave our plan, like permanently moving outside our service area. But we are never allowed to ask you to leave the plan because of your health.

Whether leaving the plan is your choice or not, this section explains the disenrollment rules and your coverage choices after you leave.

Voluntarily ending your membership

You can change health plans only at certain times during the year.

There is a Special Election Period (SEP) for individuals who have both Medicare Parts A and B and receive any type of assistance from Medicaid.

The SEP starts the month you become dually eligible and continues as long as you receive Medicaid benefits. However, there are limits in how often it can be used. The SEP allows an individual to enroll in, or disenroll from, an MA plan once per quarter during the first nine months of the calendar year. That means, the SEP can be used one time during each of the following time periods:

  • January – March
  • April – June
  • July – September

When you make a request using the SEP, your enrollment status is effective the first day of the month following receipt of the request. Your enrollment in your new plan will also begin on this day. The SEP is considered used during the month it is requested.

The SEP may not be used in the 4th quarter of the year (October-December). From October 15 to December 7, you can join, switch or drop a Medicare health or drug plan for an effective date of January 1 of the following year.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan. However, if you want to switch from our plan to Original Medicare but have not selected a separate Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:

  • Make a request in writing to:

MCC of AZ (HMO SNP)
58 Charles Street
Cambridge, MA 02141

  • Contact Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 711) 24 hours a day, 7 days a week

For more information, call Member Services at 1-800-424-4509 (TTY 711).

If you leave our plan, it may take some time for your membership to end and your new coverage to take effect. During this time, you are still a member and must continue to get your care as usual through MCC of AZ (HMO SNP).

If you receive services from providers who are not part of our plan before your membership ends, neither we nor Medicare will pay for these services. However, there are a few exceptions:

  • Urgently needed care
  • Emergency care
  • Care that has been approved by us
  • Hospitalization that begins on the last day of membership (our plan will cover this care until discharge)
Involuntarily ending your membership

MCC of AZ (HMO SNP) must end your membership in the plan if any of the following happen:

  • You do not stay continuously enrolled in Medicare Part A and Part B
  • You are no longer eligible for Medicaid
  • You move out of our service area
  • You are away from our service area for more than six months
    • If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area.
  • You become incarcerated (go to prison)
  • You lie about or withhold information about other insurance you have that provides prescription drug coverage
  • You intentionally give us incorrect information that information affects your eligibility for our plan
    • We cannot make you leave our plan for this reason unless we get permission from Medicare first
  • You continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan
    • We cannot make you leave our plan for this reason unless we get permission from Medicare first
  • You let someone else use your membership card to get medical care
    • We cannot make you leave our plan for this reason unless we get permission from Medicare first
    • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General
  • You are required to pay the extra Part D amount because of your income and you do not pay it
    • Medicare will disenroll you from our plan

If we end your membership in our plan, we must tell you our reasons in writing. We must also explain how you can make a complaint about our decision to end your membership. Please call Member Services for more information.

We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave because of your health, you should call 1-800-MEDICARE (1-800-633-4227), the national Medicare help line. TTY users should call 1-877-486-2048 You may call 24 hours a day, 7 days a week.