Medi-Cal Aklat-Gabay ng Miyembro at Katibayan ng Pagkakasakop

Last Updated 08/28/2017

Medi-Cal2018 Aklat-Gabay ng Miyembro at Katibayan ng Coverage

i2017 Medi-Cal EOC

(HPSM) 1-800-750-4776 650-616-2133

/

ii 2017 Medi-Cal EOC

()

(Pharmacy Benefit Manager)

-

iii2017 Medi-Cal EOC

() ()

50 50

iv 2017 Medi-Cal EOC

HIV/AIDS

www.hpsm.org/documents/HPSM_Notice_of_Privacy_Practices.pdf

1. 2. 3.

vi

vi

(accounting of disclosures) ()

v2017 Medi-Cal EOC

() vi ( 3 ) 2003 4 14

vi

(2) (The Secretary, U.S. Department of Health & Human Services)

vi

()

vi 2017 Medi-Cal EOC

2013 9 23 60 http://www.hpsm.org/privacy-policy.aspx

(1) (U.S. Department of Health and Human Services)

Grievance CoordinatorHealth Plan of San Mateo 801 Gateway Blvd., Suite 100South San Francisco, CA 940801-888-576-7557 650-616-2850

Secretary of the U.S.Department of Health and Human ServicesOffice of Civil Rights Attn:Regional Manager50 United Nations Plaza, Room 322 San Francisco, CA 94012

(U.S. Office for Civil Rights) 1-866-627-7748 1-866-788-4989 TTY(OCR-PRIV)

(2)

Attention: Privacy Officer Health Plan of San Mateo 801 Gateway Blvd., Suite 100South San Francisco, CA 94080650-616-0050

(HPSM) 1-800-750-4776 650-616-2133 TTY 1-800-735-2929 7-1-1 (CRS)

vii2017 Medi-Cal EOC

(HPSM)

y

y

Member Services 801 Gateway Blvd., Suite 100South San Francisco, CA 940801-800-750-4776 650-616-2133TTY () 1-800-735-2929650-616-8581

(U.S. Department of Health and Human Services) (Office for Civil Rights) (https://ocrportal.hhs.gov/ocr/portal/lobby.jsf)

U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C.20201 1-800-368-1019, 800-537-7697 (TDD )http://www.hhs.gov/ocr/office/file/index.html

viii 2017 Medi-Cal EOC

English:ATTENTION: If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929).

Spanish:ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Llame al 1-866-880-0606 (TTY: 1-800-855-3000).

Chinese: 1-866-880-0606 TTY1-800-735-2929

Tagalog:PAUNAWA: Kung nagsasalita kayo ng Tagalog, maaari kayong gumamit ng mga serbisyo ng tulong para sa wika nang walang bayad. Tumawag sa 1-866-880-0606 (TTY: 1-800-735-2929).

Russian:: , . 1-866-880-0606 (: 1-800-735-2929).

Vietnamese:CH : Nu bn ni Ting Vit, c cc dch v h tr ngn ng min ph dnh cho bn. Gi s 1-866-880-0606 (TTY: 1-800-735-2929).

Korean:: , . 1-866-880-0606 (TTY: 1-800-735-2929) .

Arabic:

: . 866-880-0606-1

( : 800-735-2929-1).

Hindi: : 1-866-880-0606 (TTY: 1-800-735-2929)

Japanese: 1-866-880-0606TTY: 1-800-735-2929

ix2017 Medi-Cal EOC

Armenian: , : 1-866-880-0606 (TTY () 1-800-735-2929):

Cambodian: , 1-866-880-0606 (TTY: 1-800-735-2929)

Farsi: : . (TTY: 1-800-735-2929) 0606-880-866-1 .

Hmong:LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-866-880-0606 (TTY: 1-800-735-2929).

Punjabi : , 1-866-880-0606 (TTY: 1-800-735-2929)

Thai

: 1-866-880-0606 (TTY: 1-800-735-2929).

xi2017 Medi-Cal EOC

......................................................................................................i .................................................................................................... i ........................................................................................................................ i ............................................................ i ............................................................................................................................. ii

.......................................................................................................................................... iv .......................................................................................................................................... iv ...................................................................................................... iv ...................................................................................................................... vi ...................................................................................................................... vi ................................................................................................................................ vi

...................................................................................... vii

Medi-Cal(() ) 2017 ...................................................................................1 ........................................................................................................................................... 1 ............................................................................................................... 1 ................................................................................................................................... 1 ....................................................................................................................... 2 ....................................................................................................... 2 ....................................................................................................... 21990 ............................................................................................................... 2 ............................................................................................................... 2 ....................................................................................... 2 ................................................................................................. 3 ......................................................................................................... 3

........................................................................................................... 3 ................................................................................................. 3

........................................................................................................................... 3

1 ..................................................................................................................5

2 ........................................................................................................9 (HPSM) ..................................................... 9 (HPSM) ................................................... 10

3 ................................................................................................... 11 (PCP) ....................................................................................... 11 (PCP) ......................................................................................... 11 (PCP) ................................................................................................. 12 ........................................................................................................................... 13 ................................................................................................... 13 ............................................................................... 14 ............................................................................................... 14 ................................................................................... 14

xii 2017 Medi-Cal EOC

4 ............................................................................................ 15 ..................................................................................................................................... 15 ....................................................................................... 16 ................................................................................................................................... 16 ........................................................................................................................... 17 ................................................................................................... 18 ............................................................................................................... 18 ........................................................................................................................... 18 (TAR) .......................................................................................................... 18 ................................................................................................... 20 ........................................................................................... 20 ........................................................................................................................... 21

......................................................................................................................... 21 ................................................................... 21 ....................................................................................................... 22 ....................................................................................................................... 22 ....................................................................................................... 22

......................................................................................................................................... 23 ............................................................................................................................... 23 ........................................................................................................................... 23/ .................................................................................................. 24 ................................................................................................... 24 ............................................................................................................... 24 ................................................................................................................... 24 ........................................................................................... 25 ........................................................................................................... 25 ........................................................................................................... 25 (PA) ............................................................................ 25 (PA) ........................................... 26Medicare(())Medi-Cal (() ) ................................................................... 26

5 ..................................................................... 27 () .............................................................................................................. 27 ........................................................................................................................... 27 () ............................................................................... 27 () ........................................................................... 28 () ( () ) ........ 28 () () ................................ 28 () ( () ) ................ 29OHC ........................................................................................................... 29

6 () ................................................................................................................ 31 ......................................................................................................................................... 31 ............................................................................................... 32

xiii2017 Medi-Cal EOC

* ............................................................................ 33 ....................................................................................... 33

......................................................................................................................... 53 (CHDP) .................................................................................. 53 (EPSDT) ........................................................................ 53 (CCS) ................................................................................................. 53 ............................................................................................................... 54 (GHPP).............................................................. 54

................................................................. 54

7 ............................................................................................ 57 ......................................................................................................... 57 ......................................................................................................... 57

8 ...................................................................................................... 59 ............................................................................................................................. 59 ..................................................................................................................... 59 ............................................................................................................................. 60 ..................................................................................................................... 60 ......................................................................................................................... 61 ......................................................................................... 61/ .................................................... 62 ................................................................................................................. 62 ................................................................................................................................... 62

DHCS () ................................................... 62

9 ................................................................................................................ 63 (COB) .......................................................................................................... 63 ......................................................................................................... 63 ................................................................................................................. 63 () ......................................................................... 63 ................................................................................................................................. 64

10 ................................................................................................................ 65 ................................................................................................................................. 65 ................................................................................................................. 65 ......................................................................... 65 ..................................................................................................................... 65 ............................................................................................................................. 65 ......................................................................................................................... 66 ......................................................................................................... 66 ..................................................................................................................................... 66 ................................................................................................................. 66

12017 Medi-Cal EOC

(HPSM)Medi-Cal ( () )

2017

(HPSM) () (SSI) () () ()

(HPSM)

y y y y

() ()

801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 1-800-750-4776 650-616-2133 1-800-735-2929 (TTY) 7-1-1 1-800-855-3000 8:00 6:00 9:30 6:00 8:00 5:00

2 2017 Medi-Cal EOC

y

y 24

y y

y () ()

y

1-800-735-2929 (TTY) 7-1-1 1-800-855-3000

(2)

1990 1990 (ADA)1973 504

59

32017 Medi-Cal EOC

1

y () y () y

7 24 (NAL) NAL 1-866-535-6977

7 24

TTY ()

1-800-735-2929 7-1-1 7 24

1-800-750-4776 650-616-2133

y y y

y

y

4 2017 Medi-Cal EOC

y y

y

y

y y

y

y

y

y

() (Human Services Agency) 1-800-223-8383 8:00 5:00 () () 1-800-772-1213

1 52017 Medi-Cal EOC

1

(Active Labor)

(Acute Condition)

(Amendments) ()

(Appropriately Qualified Health Care Professional) ()

(Authorization) (PCP)

(Auto Assignment)

(Benefits) (Coverage) (Covered Service)

(CCS)

(Case Management)

(Clinic)

(Coverage Decision)

DMHC (Department of Managed Health Care)

(Disputed Health Care Service)

6 2017 Medi-Cal EOC 1

(Emergency Care)

()

(Established Patients OnlyEPO)

(Exclusion) ()

(Formulary)

(Grievance) /

(Health Plan) HPSM

(Identification (ID) Card) ID

(Investigational Services)

(Life Threatening)

(Medical Emergency) []


(Medical Group)

(Medically Necessary) (Medical Necessity)

(Member) ()

(Out-of-Area Care)

(Participating Hospital)

(Participating Provider)

(Pharmaceutical Benefits ManagerPBM)

(Primary Care ProviderPCP)

(Prior Authorization)

(Provider List)

(Referral)

(Serious Chronic Condition)

(Service Area)


(Special Member)

(Specialist) (Referral Provider)

(State)

(Terminal Illness)

(Treatment Authorization RequestTAR) /

(Urgent Care) /


2

(HPSM) y

y

y (PCP)

y y

y

y y

y y

y y

y ()

y y

y y


(HPSM) y

y 24

y ()

y y

y y (PCP) y y y y (PCP) y

y

y () (SSI)

y y


3

19

(3) () 1-800-750-4776 650-616-2133

(PCP)/

(4)

(PCP)y /


y

(PCP)

y y y y

/

/ 30 ()

(1) (EPO)(2) (3) (4)


(10) () 1-800-750-4776 650-616-2133

HPSM

30 ()

() 30

1-800-750-4776 650-616-2133

y y ( (12) )

y y y (36) (12) y 180

1-800-750-4776 650-616-2133


59

1-888-HMO-2219 TDD 1-877-688-9891 ( HMO ) www.hmohelp.ca.gov

(12) y y ( 12 )

y y y 36 12 y 180

1 5 8 1-800-750-4776 650-616-2133

()

(60)

(FHQC)


4

() (California Department of Health Care Services) () (BIC)

(ID ) (10) 1-800-750-4776 650-616-2133

www.hpsm.org

HPSM Member Services: 1-800-750-4776

Medi-Cal

Member DOB

HPSM Medi-Cal ID Assigned to PCP as of

Group Plan (80840) HPSM Member as of7740 283 982PCP Medicare:

Submit medical claims to:HPSM Claims Department801 Gateway Blvd., Suite 100South San Francisco, CA 94080Claims Department: 650-616-2056Provider Services: 650-616-2106

Submit pharmacy manual claims to:Argus Health SystemsDepartment 586P.O. Box 419019Kansas City, MO 641411-888-635-8362

For Provider Use Only For Provider Use Only For Provider Use OnlyProviders with a PIN can check member eligibility verification 24 hours a day at 1-800-696-4776, or online at www.hpsm.org.

Emergency services do not require pre-authorization.For information about Mental Health Services call 1-800-686-0101.

In case of emergency, call 9-1-1 or seek appropriate emergency care.

(DOB)

(PCP)

1-800-750-4776 650-616-2133


() (BIC)

24 y y ()

y

30

7 24

(Nurse Advice Line) 7 24 1-866-535-6977TTY () 1-800-735-2929 7-1-1

() 24

1-800-750-4776 8:00 6:00 9:30 6:00

TTY () 1-800-735-2929 () 7-1-1

(PCP) (4)


15 () (BIC)

/

2 (48 )

4 (96 )

2 (10 )

3 (15 )

2 (10 )

3 (15 )

X

24 (1 ) 3


( X ) 1-800-750-4776 650-616-2133

1-800-750-4776 650-616-2133 59

1-800-750-4776 650-616-2133

(TAR) (TAR) /


(/)

(1) (2)

/

()

() ()

/

y (90) y (90) (DSS) y (IMR)

(5) 72 ()


()

1. 2. ()/

3. / (STD) HIV/AIDS (STI) (STD) HIV/AIDS () () 41 43 (California Office of Family Planning) (Information & Referral Service) 1-800-942-1054

4. () 18 5. 2

6. - 14

(PCP) (Nurse Advice Line) 1-866-535-6977 7 24

(HPSM)


24

() ()

y

y

y

y

9-1-1 (BIC)

()


1-800-750-4776 () 650-616-2133 8:00 6:00 9:30 6:00TTY () 1-800-735-2929 7-1-1

9-1-1 (Medicaid) ( () ) ()/

()

() (BIC)

y y


y y y y

72

59

() () 26 ()()

Kaiser Foundation Kaiser

(PBM) Argus Health Systems Argus Health Systems


/

() () www.hpsm.org 1-800-750-4776 650-616-2133 (FDA) () ()

()

(FDA) y

y y

y (DAW) (PA)

y () (PA) /


(Food and Drug AdministrationFDA) (FDA)

90 90

(PA) y y HPSM y

650-829-2045 8:00 5:00

(1) (5)

(PA) 8:00 5:00 (PBM) Argus Health Systems 1-888-635-8362


(PA)

() () () () Part D () (PDP) () () Advantage (MA-PD) PDP MA-PD 1-800-MEDICARE () Advantage (MA-PD)

() () y - (PDP) ()

Advantage (MA-PD) y ()y y

HPSM () HPSM () () (Member Services Department)


5

() ()

() y () y ()y ()

y ()

y ()

() ()

Member Services DepartmentHealth Plan of San Mateo801 Gateway Blvd., Suite 100South San Francisco, CA 94080

90 (3 ) ()

() () $1.00 ( () () )


$5.00y 18 y y 60 y y () () y y y $10

()

() () ()

() 1-800-223-8383

() ( () ) () TMC () () () 12

1-800-223-8383

() () () () y 65 y y


() () ()

() y () Part A y () Part B X y () Part D y () Parts ABD () () ()

()

() ( () ) Blue CrossKaiser

()

(Human Services Agency) / (Social Security Administration)

OHC () OHC ()

(Premium Payment Coordinator)

OHC


6

()

( 8 )

y (USPSTF)

y () 1. 2. 3. 4. 5. (STD) HIV/AIDS 6. 7. 8. 9. 10.

11. 21 ()

12. 2014 5 Denti-Cal y ( ACIP ) ( ACIP ) USPSTF


15 10

( 12 )

(15 10 )

(11 21 )

2-4 1246912

1 /9-12

15182430 3 10

24 5

1121 1121

2-4 1246912

15182430 3 10

2-4 1246912

15182430 3 10

( 30 ) (3 ) (BMI)

(BMI)

12

24

//

9


*

INFO

RMAT

ION

FOR

ADUL

T PAT

IENT

S20

17 R

ecom

men

ded

Imm

uniz

atio

ns fo

r Adu

lts:

By

Ag

e

If yo

u ar

e th

is a

ge,

talk

to y

our h

ealth

care

pro

fess

iona

l abo

ut th

ese

vacc

ines

Flu

Influ

enza

Td/T

dap

Teta

nus,

dip

hthe

ria,

per

tuss

is

Shin

gle

sZo

ster

Pneu

mo

cocc

alM

enin

goco

ccal

MM

RM

easl

es,

mum

ps,

rub

ella

HP

VH

uman

pap

illom

aviru

sCh

icke

npox

Varic

ella

Hep

atit

is A

Hep

atit

is B

Hib

Hae

mop

hilu

sin

fluen

zae

type

bPC

V13

PPSV

23M

enA

CW

Y or

MPS

V4M

enB

for w

omen

for m

en

19 -

21 y

ears

22 -

26 y

ears

27 -

59 y

ears

60 -

64 y

ears

65+

yea

r

Mo

re

Info

rmat

ion

:

You

shou

ld

get fl

u va

ccin

e ev

ery

year

.

You

shou

ld

get a

Td

boo

ster

eve

ry

10 y

ears

. You

al

so n

eed

1 do

se o

f Td

ap. W

omen

sh

ould

get

a

Tdap

vac

cine

du

ring

ever

y p

regn

ancy

to

help

pro

tect

th

e b

aby.

You

shou

ld

get s

hing

les

vacc

ine

even

if

you

have

ha

d sh

ingl

es

bef

ore.

You

shou

ld g

et 1

dos

e of

PC

V13

and

at le

ast 1

dos

e of

PPS

V23

dep

endi

ng o

n yo

ur a

ge a

nd

heal

th c

ondi

tion.

You

shou

ld g

et H

PV v

acci

ne if

yo

u ar

e a

wom

an th

roug

h ag

e 26

yea

rs o

r a m

an th

roug

h ag

e 21

yea

rs a

nd d

id n

ot a

lread

y co

mp

lete

the

serie

s.

Rec

om

men

ded

Fo

r Yo

u:

This

vac

cine

is

reco

mm

ende

d fo

r you

unless

your

hea

lthc

are

pro

fess

iona

l tel

ls y

ou th

at y

ou d

o no

t nee

d it

or

shou

ld n

ot g

et it

.

May

Be

Rec

om

men

ded

Fo

r Yo

u:

This

vac

cine

is

reco

mm

ende

d fo

r you

if y

ou h

ave

cert

ain

risk

fact

ors

due

to y

our h

ealt

h co

nditi

on o

r oth

er. T

alk

to y

our h

ealt

hcar

e p

rofe

ssio

nal t

o se

e if

you

need

th

is v

acci

ne.

You

sh

ou

ld g

et th

is v

acci

ne

if y

ou

did

no

t get

it w

hen

yo

u w

ere

a ch

ild.

If y

ou

are

trav

elin

g o

uts

ide

the

Un

ited

Sta

tes,

yo

u

may

nee

d a

dd

itio

nal

vac

cin

es.

Ask

you

r hea

lthca

re p

rofe

ssio

nal a

bout

whi

ch v

acci

nes

you

may

nee

d at

leas

t 6 w

eeks

bef

ore

you

trav

el.

For m

ore

info

rmat

ion,

cal

l 1-8

00-C

DC-

INFO

(1

-800

-232

-463

6) o

r vis

it w

ww

.cdc

.gov

/vac

cine

s

CS2

7288

6-G


Tech

nica

l con

tent

rev

iew

ed b

y th

e C

ente

rs fo

r D

isea

se C

ontr

ol a

nd P

reve

ntio

n

Sain

t Pau

l, M

inne

sota

65

1-64

7-90

09

ww

w.im

mun

ize.

org

w

ww

.vac

cine

info

rmat

ion.

org

ww

w.im

mun

ize.

org/

catg

.d/p

405

0.pd

f I

tem

#P

405

0 (2

/16)

fo

otn

ote

s1

Your

chi

ld m

ay n

ot n

eed

this

dos

e de

pend

ing

on th

e ty

pe o

f vac

cine

that

yo

ur h

ealth

care

pro

vide

r us

es.

2 Th

is d

ose

of D

TaP

may

be

give

n as

ea

rly

as a

ge 1

2 m

onth

s if

it ha

s be

en

6 m

onth

s si

nce

the

prev

ious

dos

e.

Whe

n D

o C

hild

ren

and

Teen

s N

eed

Vacc

inat

ions

?

Age

Hep

BH

epat

itis

B

DTa

P/Td

apD

ipht

heri

a,

teta

nus,

per

tuss

is

(who

opin

g co

ugh)

Hib

Hae

mop

hilu

s influenzae

type

b

IPV

Polio

PCV

13Pn

eum

ococ

cal

conj

ugat

e

RVR

otav

irus

MM

RM

easl

es,

mum

ps, r

ubel

la

Vari

cella

Chi

cken

pox

Hep

AH

epat

itis

A

HPV

Hum

an

papi

llom

avir

us

Men

-A

CW

YM

enB

Influenza

Fl

u

Men

ingo

cocc

al

Bir

th

(b

efor

e ho

spi-

tal d

isch

arge

)

2 m

onth

s

4

mon

ths

1

6

mon

ths

(61

8 m

os)

1

(61

8 m

os)

1

(One

dos

e ea

ch fa

ll or

wi

nter

to a

ll pe

ople

age

s 6

mos

and

ol

der.

Som

e ch

ildre

n yo

unge

r th

an a

ge 9

ye

ars

need

2

dose

s; a

sk

your

chi

lds

heal

thca

re

prov

ider

if

your

chi

ld

need

s m

ore

than

1 d

ose.

)

12 m

onth

s

2

(15

18 m

os)

(12

15 m

os)

(12

15 m

os)

(12

15 m

os)

(12

15 m

os)

(2 d

oses

giv

en

6 m

os a

part

at a

ge 1

223

m

os)

15 m

onth

s

18 m

onth

s

192

3 m

onth

s

46

year

s

7

10 y

ears

111

2 ye

ars

(Tdap)

131

5 ye

ars

161

8 ye

ars

1


B (HIB) 5 ()

A A A

B B (HBV) () 18

(Flu) 6 6-23

90% 11 12

()2010


12-15

()

()

Tdap ()5 Td Tdap Td 10 ()


()

X ()

()

y


()

y (24) ()

y y

()


14 (FDA) Norplant 23

() ( 62 )

() () ( (PKU) )

(BHRS ACCESS Call Center)1-800-686-0101

1-800-686-0101 8:00 5:00TDD () 1-800-943-2833

9-1-1

(Mental Health Services Patient Rights Advocate)1-800-497-1889 650-341-1889


(BHRS) ( 1-800-686-0101) (PCP)*y ()y y y y

y *

* (DSM- IV)

(HPSM) (ASD) (BHT)

y y y y

y 21 y y /


y y 24 y (ICF/ID)

1-800-750-4776 1-800-686-0101

y

18 **y y 15

(PCP)

** (SBIRT)

FDA () IUD Norplant FDA 12 FDA X


() HIV (STD)

() () (California Department of Health Care Services) 1-800-942-1054

(California Department of Health Care Services) 1-800-942-1054

( 18 )

(STD)

18 () 12

/


48 96 48 96 48 y () (CNM) / (OB) (CNM) (Health Promotion Specialist) 650-616-2165 ()

(CPSP) (WIC)

y 650-616-2165 (Health Education) (Health Promotion Coordinator) 650-616-2855 10 15 12 $15 Target What to do When You are Having a Baby $50 Target $40 Safeway

X

X


(DME)

()

9-1-1

() () (Nurse Advice Line)1-866-535-6977


(NEMT)

NEMT NEMT NEMT

NEMT

NEMT (5) () () ( )

NEMT

(/EOC)

(EPSDT) (EPSDT) / (NMT) [1]

() / NMT

[1] 21 (EPSDT) / EPSDT


NMT (2) () American Logistics (ALC) 1-844-856-4389

NMT EPSDT NMT 1.

NEMT 2. (/EOC)

(CBAS) (HPSM)


/

(ADHC)

SNF (/) (SNF) (SNF)

24 () X ( 48 ) ( 48 )

21


() () ()

() (2) /

(HPSM)

21 (HPSM)

21


() 21

() ()

y y ()

y


y

y

650-616-2165

/ ()

y () () (Centers of Excellence) () ()


() y (CCS) ( 21 ) (GHPP) ( 53 54 )

y

y y

y

y

()


1) 2)

21 (CCS) ( 53 ) ()

(IMR) 61

y FDA y y y y y

(PKU)() () / ()


(CHDP) 21

(EPSDT) () () 21 ()

(CCS)2013 4 21 (12) (CCS)

()

1. 2013 4 1

2.

(San Mateo Health Department) 650-616-2500http://smchealth.org/ccs


()

(GHPP) (State of California Department of Health)

1-800-639-0597

() () (WIC) 650-573-2168 (Golden Gate Regional Center) 650-574-9232 () (Denti-Cal) 1-800-322-6384 1-800-686-0101

y y y (IHSS)

1-800-675-8437 650-573-3900

(LTSS) 2014 y (MSSP) 65


/

y (IHSS) 65 ()

1-800-675-8437 650-573-3900


7

() () (*)

1.

2. ()

(IMR) 61

3.

4.

5.

6. () ()


7. () () () 1-800-322-6384 Denti-Cal () 21 () (Denti-Cal) ()

8.

9.

10.

11. ()

12. EPSDT

13.

14. 21


8

(grievance) (appeal)

(90) ()

Kaiser Foundation Kaiser Kaiser Kaiser Foundation Kaiser 1-800-464-4000 1-800-777-1370 (TTY)

Kaiser Permanente Redwood City

1-800-750-4776 650-616-2133 1-888-576-7227 650-616-2850 ()

Grievance and AppealsHealth Plan of San Mateo801 Gateway Boulevard, Suite 100South San Francisco, CA 94080 1-888-576-7227 650-616-2850 650-829-2002www.hpsm.org

(5) (30) ()


(3)

1. 2. 72

() 120 10 ()

1-800-952-5253 (TTY) 1-800-952-8349

State Department of Social ServicesState Hearings DivisionPost Office Box 944243Mail Station 19-37Sacramento, Ca 94244-2430 916-229-4110

(2) (3) 10 () 1-888-452-8609 1-888-576-7227 650-616-2850


Expedited Hearing UnitState Hearings Division744 P StreetMS 19-65SacramentoCA 95814916-229-4267

(IMR) (Department of Managed Health Care DMHC)

1. (a) (b) (c)

2.

3. 30 ()

(DMHC)

DMHC (30) (3) (3)

1-800-750-4776 650-616-2133 1-888-576-7227 650-616-2850 (CRS) TTY 1-800-735-2929 7-1-1


/ (Department of Managed Health Care) y (5) /

y /

y (7)

(California Department of Managed Health Care) 1-888-576-7227 650-616-2850 (CRS) 1-800-735-2929 7-1-1 30 (Independent Medical ReviewIMR) 1-888-HMO-2219 TDD (1-877-688-9891) (http://www.hmohelp.ca.gov)

(30)

DHCS () () 1-888-452-8609


9

(COB) () () ()

( $10 ) () ()

() 1-800-223-83831-800-772-1213

/

() () 55 () () () / 916-650-0490


() /

() 55 1-916-650-0490

(DMV) (http://www.organdonor.gov) 1-800-355-SHARE (1-800-355-7427)

652017 Medi-Cal EOC 10

10

90 ()

()

() ()


( ivi) 1-800-750-4776 650-616-2133 www.hpsm.org

(HIV) (AIDS) (ARC)

(CAC)

Daly City

SouthSan Francisco

San Bruno SFOPacifica

Montara

Moss-Beach

Half Moon Bay

MillbraeBurlingame

HillsboroughSan Mateo

Belmont

San Carlos

Redwood CityEast Palo Alto

Menlo Park

AthertonWoodside

PortolaValley Santa Clara County

San Mateo CountyEl Condado de San Mateo

Foster City

N

EW

S

801 Gateway Boulevard, Suite 100 South San Francisco, CA 94080 tel 800.750.4776 toll-freetel 650.616.0050 local fax 650.616.0060 tty 800.735.2929 or dial 7-1-1www.hpsm.org

Kalusugan ay para sa lahat.

MC-EOC 2018_Cover_TA (Split Cover)-Dec2017-r2MC-EOC_2017_tc

Documents

Medi-Cal Aklat-Gabay ng Miyembro at Katibayan ng Pagkakasakop