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Hamaspik Medicare Choice(HMO D-SNP)
Get the best of both worlds
With comprehensive care you can count on
Enrolling now will bring you one step closer to Medicaid
and Medicare coverage in a single, all-inclusive plan.
Your prescription for better health
How Hamaspik makes getting your prescriptions a priority
Broad Formulary of Covered Medications
Each Hamaspik plan uses an established drug list (known as ‘The Formulary’) that has been approved by CMS (The Centers for Medicare and Medicaid Services). The drug list includes both brand name and generic drugs in all medication categories. Just speak with your doctor about the drugs you need, and show them the formulary for your plan.
Vast Pharmacy Network
You can get your medications at any of the thousands of pharmacies in our network, including all major drug store chains and many independent pharmacies. You can also order your medications to be delivered via mail.
Flexible Options
If you are taking a drug that is not included in the Hamaspik Medicare Select formulary, we will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new, and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication. The prescription must be filled at a network pharmacy. This will ensure that your health needs are always met. Be sure to talk with your doctor during this time to prescribe a different drug or to file an exception request.
Medication Therapy Management Program (MTMP) Requirements
To be enrolled in MTMP, individuals must meet the following criteria.
1
You have certain chronic illnesses that are common among Medicare beneficiaries, especially if you have 3 or more of the following diagnoses:
- Alzheimer’s disease
- Diabetes Mellitus
- Dyslipidemia
- Hypertension
- Chronic Obstructive Pulmonary Disorder (COPD)
2
You take at least 5 ongoing medications to manage your chronic illnesses
3
You are likely to incur an annual cost of $4,376 or more for your prescription drugs (based on the cost of prescriptions you filled in the previous 3 months)
How MTMP Enrollment Works
Step 1
Engage
If you are found to be eligible for the MTMP, you will be automatically enrolled in the program. If you do not wish to participate, notify us at any time by calling 1-800-424-9342, and we will remove you from the MTMP. Hours are 9:00am to 5:00pm, Monday to Friday.
Step 2
Review
A key component of the program is the Comprehensive Medication Review (CMR), which you will complete with one of our pharmacists during a telephone consultation. The CMR typically takes between 15 and 30 minutes. During that time, the pharmacist will answer any questions you have about your medications, the best time to take them, and more.
Step 3
Reflect
A written summary of the discussion will be sent to you within 14 days. The written summary will include a letter, personal medication list and medication action plan. We encourage members to bring these documents to their physician visits to discuss the information provided.
Step 4
Reevaluate
In addition to CMR, members who participate in MTMP will be included in various Targeted Medication Reviews (TMRs) conducted throughout the year on a quarterly basis. TMRs use pharmacy claims data to assess eligible members’ medication profiles for medication-related issues or gaps in care. Any recommendation that is identified through the TMR will be sent to your physician so they may assess it during your next visit.
Care that benefits you
Unlimited Access
Hamaspik Medicare Choice includes a broad range of services to keep you healthy and safe in your home. We cover all of the services you receive from your Medicare benefits, and many Medicaid benefits. With Hamaspik Medicare Choice, you receive your medical care and long term care services from one comprehensive health plan.
Vast Network
Our provider network includes hundreds of physicians in every county within our service area, covering your primary care needs plus a wide range of specialists. The network also features many of New York’s leading hospital systems, long term care providers, and their affiliated doctors.
Financial Support
As a member of a Hamaspik health plan, you are eligible for extra help in the form of a Low Income Subsidy (LIS), which helps you pay for your prescription drugs and copayments. Regardless of your income, all members receive the same high quality of care provided through our plan with full LIS Coverage.
Make the most of your benefits
with these services from our partners
Over-The-Counter Health Items
Your membership in Hamaspik Medicare Choice includes coverage for Over-the-Counter (OTC) health products.
- Members may receive up to $135 per month in benefits.
- Hamaspik Medicare Choice covers all of the OTC products that are approved by Medicare.
- OTC products will be delivered to your home at no cost to you.
- Click here to find out more, view the catalog of products, and place your order.
Quality assurance is ensured
Hamaspik has programs in place to ensure our members always receive safe, appropriate care. We are committed to providing the highest caliber of healthcare services; therefore, we have created a Quality Improvement program aimed at maintaining this focus.
Hamaspik Quality ImprovementMissing some paperwork?
Check out our Healthcare Resources Page,
or download the prescription form below:
Problem with your coverage?
If you have a concern about your healthcare or would like to file a complaint about your Hamaspik plan, please contact Member Services within 60 days of the problem. We want to understand your concerns and help you to resolve them. Depending on the situation, your case will be handled as a grievance, or as an appeal. You can file a grievance in writing, over the phone, via fax or email. You can find detailed information about grievances and appeals in your Evidence of Coverage document.
1-833-426-2774
For TTY/TDD services, call 711
Hamaspik Medicare Choice
Attn: Grievances and Appeals
58 Route 59, Suite 1
Monsey, NY 10952
quality@hamaspik.com
Fax: 1-845-503-0999
You can also file grievances with CMS by calling 1-800-MEDICARE, or online at Medicare.gov
You can file a grievance with the New York State Department of Health by calling 1-866-712-7197.
Please contact Member Services if you would like to obtain information about the aggregate number of grievances, appeals and exceptions that have been filed with your Hamaspik healthcare plan.
What to expect
After you file a grievance, Hamaspik looks carefully into your case and will seek to resolve the problem right away. We will respond with the following:
- The person who is working on your complaint
- The contact information for this individual
- Any additional information we will need to investigate your complaint
The next steps
We will investigate your concern, and will notify you of our decision within 30 days. (or within 24 hours for expedited grievances). If we choose to contest your complaint, you will be notified. Our response will include reasons for our course of action.
You will be informed on how to appeal a decision and will be provided any necessary forms. If we are unable to make a decision about your complaint due to missing information, we will also notify you.
Coverage decisions
Hamaspik Medicare Choice makes a coverage decision every time we decide what services are covered and how much we will pay. You or your doctor can also contact us to request a coverage decision if you are unsure if a particular medical service is included in your plan. If you wish to request approval for a drug that is not included in the Hamaspik Medicare Choice formulary, this is called an “exception request.” Your doctor will need to provide us with information about why you need to take the drug that you are requesting. You may also appeal any coverage determination, if you disagree with our decision.
If you have a question about how to ask for a service to be authorized, or how to file an appeal, we also encourage you to contact Member Services. Please call 833-426-2774. (TTY users, call 711.) Or send your request in writing to:
Hamaspik Medicare Choice
58 Route 59, Suite #1
Monsey, NY 10952
How to appeal
To appeal a decision about your health care services, please follow these guidelines:
- File an appeal within 60 business days of receiving our decision
- File the appeal yourself or ask someone you trust to file the complaint on your behalf
- Make sure the appeal is made in writing (even if you initially call, you must follow up in writing)
Your first appeal is referred to as a Level 1 appeal, and it is reviewed by Hamaspik Medicare Choice. If we deny your appeal, we will automatically forward it for a Level 2 appeal, which is reviewed by an independent third party. In some circumstances, other levels of appeal are also available.
Getting help
For assistance with filing a coverage decision or grievance, or appeal, contact us. Your doctor, prescriber or lawyer can also submit a request on your behalf at any point in the appeals process, including requests for Part D prescription drugs. Alternatively, you may appoint a friend, relative or another representative via the Appointment or Representative form on our
Alternative Options
If you are not satisfied with the services you have received from Hamaspik, you (or someone on your behalf) may submit a complaint directly to Medicare by calling 1-800-MEDICARE or 1-800-633-4227. Or you can file your grievance with Medicare on-line by visiting medicare.gov.
You can file a grievance with the New York State Department of Health by calling 1-866-712-7197. If you need assistance requesting a coverage decision or filing a grievance or an appeal, we also encourage you to contact Member Services. Please call 833-426-2774. (TTY users, call 711.)
Hamaspik Medicare Choice
Attn: Care Management
58 Route 59, Suite 1
Monsey, NY 10952
Participant Ombudsman
The Participant Ombudsman, called the Independent Consumer Advocacy Network (ICAN), is an independent organization that provides free ombudsman services to long term care recipients in the state of New York. You can get free independent advice about your coverage, complaints, and appeal options. They can help you manage the appeal process.
They can also provide support before you enroll in a MAP plan like Hamaspik Medicare Choice. This support includes unbiased health plan choice counseling and general program related information.
Contact ICAN to learn more about their services:
- Phone: 1-844-614-8800 (TTY users, please call: 711)
- Web: www.icannys.org
- Email: ican@cssny.
org
Notice of Non-Discrimination
Hamaspik Medicare Select complies with federal civil rights laws and does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. We also provide the following:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats and more)
- Free language translation services to people whose first language is not English, such as qualified interpreters and information written in other languages
If you need services, contact Member Services. Or, if you believe Hamaspik has not given you these services or has treated you differently for any reason, you can file a grievance with Hamaspik:
In person: at the address listed above
Mail: Hamaspik Medicare Choice
Attention: Grievances and Appeals
58 Route 59, Suite 1
Monsey, NY 10952
Phone: 1-833-426-2774
For TTY/TDD services, call 711
Fax: 1-845-503-0999
Email: quality@hamaspik.com
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights via:
Web: OCR Complaint Portal at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Mail: U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F,
HHH Building
Washington, DC 20201
Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html
Phone:
1-800-368-1019
For TTY/TDD, call 800-537-7697
We never stop caring for you
For assistance with any of the following,
contact our dedicated member service team 1-833-426-2774, For TTY/TDD services, call 711,
Mon - Fri, 8AM - 8PM.
Understanding your health plan coverage
Resolving a concern about your services
Finding a provider or changing your PCP
Replacing a lost Hamaspik ID card
Submitting concerns or positive feedback
Questions about plan enrollment
Getting enrollment status updates
… and more
One click to care
Your resource for quality care
Get the care you need, the information you want,
and your questions answered—all here on our site.
and your questions answered—all here on our site.
Hamaspik Medicare Choice is a Medicare Advantage and Prescription Drug Plan (HMO D-SNP) with a Medicare contract, and a Medicaid Advantage Plus (MAP) plan with a New York State contract. Enrollment in Hamaspik Medicare Choice depends on contract renewal. This information is not a complete description of benefits. For a complete list of covered services and other important information, please review the Evidence of Coverage.
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