bronx - kings - new york - queens · 6jku rncp fqgu pqv jcxg c fgfwevkdng +u vjgtg cp[ nkokv qp jqy...
TRANSCRIPT
AlphaCare of New York, Inc.H9122_DSNPSBD090914 CMS Accepted 09/09/14
AlphaCare Total (HMO SNP)
5WOOCT[�QH�$GPGƂVUBronx - Kings - New York - Queens
January 1, 2015 to December 31, 2015
1
AlphaCare Total (HMO SNP)
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AlphaCare Total (HMO SNP)
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AlphaCare Total (HMO SNP)
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11
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12
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$0 or $5 copay
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13
AlphaCare Total (HMO SNP)
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14
AlphaCare Total (HMO SNP)
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15
AlphaCare Total (HMO SNP)
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16
AlphaCare Total (HMO SNP)
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17
AlphaCare Total (HMO SNP)
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18
AlphaCare Total (HMO SNP)
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19
AlphaCare Total (HMO SNP)
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20
AlphaCare Total (HMO SNP)
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21
AlphaCare Total (HMO SNP)
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22
AlphaCare Total (HMO SNP)
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1WVRCVKGPV�2TGUETKRVKQP�&TWIUEQPVKPWGF�QP�VJG�PGZV�RCIG�
/GFKECKF�FQGU�PQV�EQXGT�2CTV�&�EQXGTGF�FTWIU�QT�EQRC[U�
/GFKECKF�2JCTOCE[�$GPGƂVU�CNNQYGF�D[�5VCVG�.CY�UGNGEV�FTWI�ECVGIQTKGU�GZENWFGF�HTQO�VJG�/GFKECTG�2CTV�F�DGPGƂV�CPF�EGTVCKP�/GFKECN�5WRRNKGU�CPF�'PVGTCN�(QTOWNC�YJGP�PQV�EQXGTGF�D[�/GFKECTG�
&TWIU�EQXGTGF�WPFGT�/GFKECTG�2CTV�$6JGTG�KU�PQ�[GCTN[�FGFWEVKDNG�HQT�/GFKECTG�2CTV�$�FTWIU�
;QW�RC[����QT�����QH�VJG�HQT�
/GFKECTG�2CTV�$�EJGOQVJGTCR[�FTWIU�CPF�QVJGT�2CTV�$�FTWIU�
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23
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
1WVRCVKGPV�2TGUETKRVKQP�&TWIU�EQPVKPWGF�
*QOG�+PHWUKQP�&TWIU��5WRRNKGU�CPF�5GTXKEGU���EQRC[�HQT�JQOG�KPHWUKQP�FTWIU�VJCV�YQWNF�PQTOCNN[�DG�EQXGTGF�WPFGT�2CTV�&��6JKU�EQUV��UJCTKPI�COQWPV�YKNN�CNUQ�EQXGT�VJG�UWRRNKGU�CPF�UGTXKEGU�CUUQEKCVGF�YKVJ�JQOG�KPHWUKQP�QH�VJGUG�FTWIU�
&TWIU�EQXGTGF�WPFGT�/GFKECTG�2CTV�&���FGFWEVKDNG
+PKVKCN�%QXGTCIG&GRGPFKPI�QP�[QWT�KPEQOG�CPF�KPUVKVWVKQPCN�UVCVWU��[QW�RC[�VJG�HQNNQYKPI�
(QT�IGPGTKE�FTWIU�KPENWFKPI�DTCPF�FTWIU�VTGCVGF�CU�IGPGTKE���GKVJGT�r� C����EQRC[�QTr� C�������EQRC[�QTr� C�������EQRC[
(QT�CNN�QVJGT�FTWIU��GKVJGT�r� C����EQRC[�QTr� C�������EQRC[�QTr� C�������EQRC[
24
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
&GPVCN�5GTXKEGU /GFKECKF�EQXGTU�/GFKECTG�FGFWEVKDNGU��EQRC[U��CPF�EQKPUWTCPEGU�
/GFKECKF�EQXGTGF�FGPVCN�UGTXKEGU�KPENWFKPI�PGEGUUCT[�RTGXGPVKXG��RTQRJ[NCEVKE��CPF�QVJGT�TQWVKPG�FGPVCN�ECTG��UGTXKEGU�CPF�UWRRNKGU�CPF�FGPVCN�RTQUVJGVKEU�VQ�CNNGXKCVG�C�UGTKQWU�JGCNVJ�EQPFKVKQP��#ODWNCVQT[�QT�KPRCVKGPV�UWTIKECN�FGPVCN�UGTXKEGU�UWDLGEV�VQ�RTKQT�CWVJQTK\CVKQP�
;QW�RC[����EQRC[�HQT�/GFKECNN[�PGEGUUCT[�FGPVCN�DGPGƂVU�
;QW�RC[����EQRC[�HQT�VJG�HQNNQYKPI�RTGXGPVKXG�FGPVCN�DGPGƂVU�r� 7R�VQ���QTCN�GZCO�GXGT[�UKZ�OQPVJUr� 7R�VQ���ENGCPKPI�GXGT[�UKZ�OQPVJUr� 7R�VQ���ƃWQTKFG�VTGCVOGPV�GXGT[�UKZ�OQPVJUr� 7R�VQ���FGPVCN�Z�TC[�GXGT[�UKZ�OQPVJU
*GCTKPI�5GTXKEGU /GFKECKF�EQXGTU�/GFKECTG�FGFWEVKDNGU��EQRC[U��CPF�EQKPUWTCPEGU�
*GCTKPI�UGTXKEGU�CPF�RTQFWEVU�YJGP�OGFKECNN[�PGEGUUCT[�VQ�CNNGXKCVG�FKUCDKNKV[�ECWUGF�D[�VJG�NQUU�QT�KORCKTOGPV�QH�JGCTKPI��5GTXKEGU�KPENWFG�JGCTKPI�CKF�UGNGEVKPI��ƂVVKPI��CPF�FKURGPUKPI��JGCTKPI�CKF�EJGEMU�HQNNQYKPI�FKURGPUKPI��EQPHQTOKV[�GXCNWCVKQPU�CPF�JGCTKPI�TGRCKTU��CWFKQNQI[�UGTXKEGU�KPENWFKPI�GZCOKPCVKQPU�CPF�VGUVKPI��JGCTKPI�CKF�GXCNWCVKQPU�CPF�JGCTKPI�CKF�RTGUETKRVKQPU�CPF�JGCTKPI�CKF�RTQFWEVU�KPENWFKPI�JGCTKPI�CKFU��GCT�OQNFU��URGEKCN�ƂVVKPIU�CPF�TGRNCEGOGPV�RCTVU�
;QW�RC[�PQVJKPI�HQT��r� &KCIPQUVKE�JGCTKPI�GZCOU�r� 7R�VQ���TQWVKPG�JGCTKPI�GZCO�GXGT[�[GCT�r� 7R�VQ���JGCTKPI�CKF�ƂVVKPI�
GXCNWCVKQP�GXGT[�[GCTr� 7R�VQ���JGCTKPI�CKF�GXGT[�VJTGG�[GCTU�
7R�VQ��������VQYCTFU�JGCTKPI�CKF�GXGT[�VJTGG�[GCTU�
25
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
8KUKQP�5GTXKEGU /GFKECKF�EQXGTU�/GFKECTG�FGFWEVKDNGU��EQRC[U��CPF�EQKPUWTCPEGU�
5GTXKEGU�QH�1RVQOGVTKUVU��1RJVJCNOQNQIKUVU�CPF�1RJVJCNOKE�FKURGPUGTU�KPENWFKPI�G[GINCUUGU��OGFKECNN[�PGEGUUCT[�EQPVCEV�NGPUGU�CPF�RQN[ECTDQPCVG�NGPUGU��CTVKƂEKCN�G[GU�UVQEM�QT�EWUVQO�OCFG���NQY�XKUKQP�CKFU�CPF�NQY�XKUKQP�UGTXKEGU�
%QXGTCIG�CNUQ�KPENWFGU�VJG�TGRCKT�CPF�TGRNCEGOGPV�QH�RCTVU��%QXGTCIG�CNUQ�KPENWFGU�GZCOKPCVKQPU�HQT�FKCIPQUKU�CPF�VTGCVOGPV�HQT�XKUWCN�FGHGEVU�CPF�QT�G[G�FKUGCUG�
;QW�RC[�PQVJKPI�HQT��r� 7R�VQ�QPG�TQWVKPG�G[G�GZCO�GXGT[�[GCTr� &KCIPQUVKE�GZCOU�KPENWFKPI�CP�CPPWCN�
INCWEQOC�UETGGPKPI�HQT�RGQRNG�CV�TKUM�r� 7R�VQ�QPG�RCKT�QH�/GFKECTG�EQXGTGF�
G[GINCUUGU�NGPUGU�CPF�HTCOGU��QT�EQPVCEV�NGPUGU�CHVGT�ECVCTCEV�UWTIGT[�
r� 7R�VQ�QPG�RCKT�QH�G[G�INCUUGU��NGPUGU�CPF�HTCOGU��CPF�EQPVCEV�NGPUGU�GXGT[�[GCT
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6TCPURQTVCVKQP�TQWVKPG� 0QP�GOGTIGPE[�VTCPURQTVCVKQP�UGTXKEGU�EQXGTGF�
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7R�VQ���QPG�YC[�VTKRU�VQ�RNCP�CRRTQXGF�NQECVKQPU�GXGT[�[GCT�
26
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
#FFKVKQPCN�%QXGTGF�5GTXKEGU
1XGT�VJG�%QWPVGT�+VGOU /GFKECKF�EQXGTU�EGTVCKP�QXGT�VJG�EQWPVGT�OGFKECVKQPU�
7R�VQ�����RGT�OQPVJ�HQT�RWTEJCUKPI�#NRJC%CTG�CRRTQXGF�PQP�RTGUETKRVKQP��QXGT�VJG�EQWPVGT�FTWIU�CPF�JGCNVJ�TGNCVGF�KVGOU�CV�RCTVKEKRCVKPI�RJCTOCE[�NQECVKQPU�
2NGCUG�EQPVCEV�VJG�RNCP�HQT�URGEKƂE�KPUVTWEVKQPU�HQT�WUKPI�VJKU�DGPGƂV�
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
/GFKECKF�1PN[�5GTXKEGU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
2TKXCVG�&WV[�0WTUKPI /GFKECKF�EQXGTCIG�RTQXKFGF�HQT�OGFKECNN[�PGEGUUCT[�RTKXCVG�FWV[�PWTUKPI�UGTXKEGU�KP�CEEQTFCPEG�YKVJ�VJG�QTFGTKPI�RJ[UKEKCP��TGIKUVGTGF�RJ[UKEKCP�CUUKUVCPV�QT�EGTVKƂGF�RTCEVKVKQPGToU�YTKVVGP�VTGCVOGPV�RNCP�
0Q�EQXGTCIG�
1WV�QH�0GVYQTM�(COKN[�2NCPPKPI�UGTXKEGU�RTQXKFGF�WPFGT�VJG�FKTGEV�CEEGUU�RTQXKUKQPU�QH�VJG�YCKXGT
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
5GEVKQP�++���5WOOCT[�QH�$GPGƂVU
27
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
/GFKECKF�1PN[�5GTXKEGU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
2GTUQPCN�%CTG�5GTXKEGU /GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
%GTVCKP�/GPVCN�*GCNVJ�5GTXKEGU /GFKECKF�EQXGTCIG�KPENWFGU�r� +PVGPUKXG�2U[EJKCVTKE�4GJCDKNKVCVKQP�
6TGCVOGPV�2TQITCOUr� &C[�6TGCVOGPVr� %QPVKPWKPI�&C[�6TGCVOGPVr� %CUG�/CPCIGOGPV�HQT�5GTKQWUN[�CPF�
2GTUKUVGPVN[�/GPVCNN[�+NN�URQPUQTGF�D[�5VCVG�CPF�.QECN�OGPVCN�JGCNVJ�WPKVU�
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6TGCVOGPV�#%6�r� 2GTUQPCNK\GF�4GEQXGT[�
1TKGPVGF�5GTXKEGU�2415�
0Q�EQXGTCIG�
/GVJCFQPG�/CKPVGPCPEG�6TGCVOGPV�2TQITCOU�//62�
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
4GJCDKNKVCVKQP�5GTXKEGU�2TQXKFGF�VQ�4GUKFGPVU�QH�1/*�.KEGPUGF�%QOOWPKV[�4GUKFGPEGU�%4U��CPF�(COKN[�$CUGF�6TGCVOGPV�2TQITCOU
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
1HƂEG�QH�2GQRNG�YKVJ�&GXGNQROGPVCN�FKUCDKNKVKGU�129&&�
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
28
AlphaCare Total (HMO SNP)
5WOOCT[�QH�/GFKECKF�%QXGTGF�$GPGƂVU
/GFKECKF�1PN[�5GTXKEGU
$GPGƂV�%CVGIQT[ 0GY�;QTM�/GFKECKF #NRJC%CTG�6QVCN�*/1�502�
%QORTGJGPUKXG�/GFKECKF�%CUG�/CPCIGOGPV
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
&KTGEVN[�1DUGTXGF�6JGTCR[�HQT�6WDGTEWNQUKU�6$��&KUGCUG
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
#+&5�CFWNV�FC[�*GCNVJ�%CTG /GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
*+8�%1$4#�%CUG�/CPCIGOGPV /GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
#FWNV�&C[�*GCNVJ�%CTG /GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
2GTUQPCN�'OGTIGPE[�4GURQPUG�5GTXKEGU�2'45�
/GFKECKF�EQXGTCIG�RTQXKFGF� 0Q�EQXGTCIG�
AlphaCare is an HMO plan with a Medicare contract. Enrollment in AlphaCare depends on contract renewal.
Call1-855-OK-ALPHA(1-855-652-5742)TTY 711
Visit Online
www.alphacae.com
Calls to this number are free. 8:00 AM to 8:00 PM, 7 days a week. Member Services also has free language interpreter services available for non-English speakers.