Plan information for Medicare Advantage members - Community Health Plan of Washington - Medicare Advantage

Plan information for Medicare Advantage members

CHPW Medicare Advantage plan information

This page has a lot of useful information about how we provide health care coverage and your rights as a CHPW Medicare Advantage member. For more details or paper copies of any of these items, contact Customer Service at 1-800-942-0247 (TTY Relay: 711), 8 a.m. – 8 p.m., 7 days a week.

Getting started

Getting care

  • How to get primary care services, including points of access*
  • How to get specialty care and behavioral health services and hospital services*
  • How to get care after normal office hours*
  • How to get emergency care, including our policy on when to directly access emergency care or use 911 services*
  • How to get care and coverage when you are out of our service area*
  • How to get information about network practitioners, including professional qualifications of primary care and specialty care providers
  • How to access virtual care (telehealth) services

Benefits and coverage

  • Benefits and services included in, and excluded from, coverage*
  • How we evaluate new technology to include as a covered benefit
  • Copayments and other charges for which you are responsible*
  • How you may submit a claim for covered services, if applicable
  • Restrictions on benefits that apply to services obtained outside our service area*
  • Pharmaceutical Management procedures

Special programs

Utilization Management (our process of reviewing whether care is medically necessary and appropriate)

Your rights and privacy

  • Our Member Rights and Responsibilities statement
  • How a member may complete an advance directive. An advance directive puts a member’s health care choices into writing and may name someone to speak for the member, if he or she is unable to speak. Advanced directives may include a Health Care Directive, Living Will, or a Durable Power of Attorney
  • How to voice a complaint
  • How to appeal a decision that adversely affects coverage, benefits, or your relationship with us
  • Our notice of privacy practices and confidentiality policies including:
    • How we use authorizations, and your right to approve the release of personal health information (PHI)
    • How to request restrictions on the use or disclosure of PHI, amendments to PHI, access to your PHI, or an accounting of disclosures of PHI
    • Our commitment to protect your privacy
    • Our policy on sharing personal health information with Plan sponsors and employers

*Information is found in your plan’s Evidence of Coverage (EOC)

DID YOU KNOW...?

Stay on Top of Your Prescriptions

Woman grabbing a prescriptionDid you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.

LEARN MORE

☏ HAVE QUESTIONS ?

Sales Team

Get real answers
from real people

Phone: 1-800-944-1247
Email: [email protected]

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