This is only a summary. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*). SBC document helps you choose a health plan. JQua/V7 25O,G RlJ E7j{ IEHP DualChoice (HMO D-SNP) This is meant to help you compare your options and understand your coverage. The Summary of Benefits and Coverage (SBC) is simple and standardized comparison document required by the Patient Protection and Affordable Care Act (PPACA). Contact the plan for details. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer. Because we respect your right to privacy, you can choose not to allow some types of cookies. Instructions for Completing the SBC - Group Health Plan Coverage and Consumer Assistance Programs. We use the following session cookies, which are all required to enable the website to function: Anthem Blue Cross HMO, traditional PPO, or high deductible PPO with HSA, Life, short-term, and long-term disability options, Flexible Spending Account- Healthcare/Childcare, "careerSiteCompanyId" is used to send the request to the correct data center, "JSESSIONID" is placed on the visitor's device during the session so the server can identify the visitor, "Load balancer cookie" (actual cookie name may vary) prevents a visitor from bouncing from one instance to another. The call is free. hYioH+ 3"> >Ivg@K, View Plan Details How to Get Care We are to help you too! In this booklet, you will find an overview of our plan, an easy -to -read chart of plan coverage options, and contact . The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Please read the Evidence of Coverage for the full list of benefits. Important Reading for IEHP Medi-Cal Members, IEHP Medi-Cal Member Services #block-googletagmanagerheader .field { padding-bottom:0 !important; } -l If you or your family is at risk of experiencing homelessness or is homeless, click here to learn more. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R] /MediaBox[ 0 0 792 615] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> w@!nRKb Mon-Fri 8am-9pm EST | Sat 8am-8pm EST. 3 0 obj Some of the services listed are covered only if IEHP or your IPA approves first. F|]u_>6|hWoU`z^b>ZMTvYMuzut/u!\z ,d$oS!*y(bS96DbX}IZ7o=e"0]-X]$`WRQ\LB6:P$CT/Y"~&! /*-->/Filter/FlateDecode/ID[<2EA2F92DEE203348B8E2055B85623233>]/Index[1175 44]/Info 1174 0 R/Length 127/Prev 402092/Root 1176 0 R/Size 1219/Type/XRef/W[1 3 1]>>stream 7500 Security Boulevard, Baltimore, MD 21244. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Learn more by clicking here. Children with Medi-Cal coverage under the Childrens Health Insurance Program (CHIP) will have a low monthly premium. Please contactMedicare.govor1-800-MEDICARE to get information on all of your options. hYmOH+qn[Z!ff{]&1`ms~XvwWU=OU]GJ*bf**mB5Tp38h&d*C t%]3L0eb6R1,1y;H$H$RZ*SJi6ZMbRl*,vj-(YO9VY!swc>=;+4I1GkWWL W''5hJXzxqu*NNhO.i)?9YV,:.9?1S&eLi.7tz1A59gAG=\?IqK5+]YjtRG|4OG43TET~o7tA)4 ? 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