Your Responsibilities

Below are things you need to do as a member of the plan.

If you have any questions, please call Member Services at 1-833-704-1177 (TTY 1-855-534-6730) 24 hours a day, seven days a week.

• Get familiar with your covered services and the rules you must follow to get these covered services.
  • Use your Member Handbook (PDF) to learn what is covered, and the rules you need to follow to get your covered services.
  • Chapters 3 and 4 of your Member Handbook give the details about your health care services, including what is covered by the plan, what is not covered, and rules to follow.
  • Chapter 7 of your Member Handbook provides details about prescription drug coverage, including what you may be required to pay.

• To be covered by AmeriHealth Caritas New Hampshire, you must receive all of your health care from the plan’s network providers except:
  • Emergency care
  • Urgently needed care when you are traveling outside of the plan’s service area
  • Family planning services
  • Care from an out-of-network provider that we have authorized in advance

• You are required to tell us as soon as possible if you have other health insurance coverage or prescription drug coverage in addition to our plan, such as Medicare or through a spouse or employer. Please call Member Services at 1-833-704-1177 (TTY 1-855-534-6730) to let us know.

• Tell your doctor and other health care providers that you are enrolled in our plan.
  • Show your AmeriHealth Caritas New Hampshire Member ID card and your New Hampshire Medicaid card whenever you get your covered services, including medical or other health care services and prescription drugs.

• Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
  • Learn as much as you are able about your health conditions, give your health care providers the information they need about you and your health. Follow the treatment plans and instructions that you and your doctors agree upon. Doing these things helps your doctors and other health care providers give you the best care.
  • Make sure your doctors and other health care providers know all of the drugs you are taking, including over-the-counter drugs, vitamins, and supplements.
  • Before you go to a specialist, talk to your primary care provider (PCP) about seeking services one, except in an emergency.
  • Keep appointments, be on time, and call in advance if you are going to be late or have to cancel your appointment.
  • Authorize your PCP to get necessary copies of all of your health records from other health care providers.
    

• If you have any questions, be sure to ask.
  • Your doctors and other health care providers will explain things in a way you can understand. If you ask a question and you do not understand the answer you were given, ask again.

• Request interpreter services if you need them.
  • Our plan has language interpreter services available to answer questions from non-English speaking members. If you are eligible for New Hampshire Medicaid because of a disability, we are required to give you information about the plan’s benefits that is accessible and appropriate for you at no cost.
  • For more information, refer to Section 2.13 (Other important information: Alternative formats and interpretation services) found in your Member Handbook.

• Respect other members, plan staff, and providers.
  • For information about when members may be involuntarily disenrolled for threatening or abusive behavior, refer to Section 11.2 (When you may be involuntarily disenrolled from the plan) found in your Member Handbook.

• Pay what you owe.
  As a plan member, you are responsible for these payments, as applicable:
  • For prescription drugs covered by the plan, you must pay a copayment, if required. Refer to Chapter 7 of your Member Handbook (Getting covered prescription drugs) to learn what you must pay for your prescription drugs.
  • If you get any health care services or prescription drugs that are not covered by our plan or by other insurance you have, you are responsible for the full cost.
  • If you disagree with our decision to deny coverage for a health care service or prescription drug, you can request an appeal. For information about how to request an appeal, refer to Chapter 10 (What to do if you want to appeal a plan decision or “action”, or file a grievance), found in your Member Handbook.

• Tell the plan if you move.
  • If you are going to move or have moved, it is important to tell us as soon as possible. Call Member Services at 1-833-704-1177 (TTY 1‑855‑534‑6730).

• Do not allow anyone else to use your AmeriHealth Caritas New Hampshire Member ID card or your New Hampshire Medicaid card.
  • Refer to Section 2.12 (How to report suspected cases of fraud, waste, and abuse), found in your Member Handbook. Notify us when you believe someone has purposely misused your health care benefits.

• Call Member Services for help if you have questions or concerns.
  • We also welcome any suggestions you may have for improving our plan. If you would like to make a suggestion, please call Member Services at 1-833-704-1177 (TTY 1-855-534-6730) 24 hours a day, seven days a week.