PHP Care Complete FIDA-IDD Plan

Here’s everything you need to get the most out of PHP Care Complete FIDA-IDD Plan (2017)

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 Participant Rights and Responsibilities

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Notice of Privacy Practices

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Summary of Benefits

Download PDF    Spanish   Haitian-Creole   Korean   Italian   Chinese   Russian


Evidence of Coverage / Participant and Family Handbook

Download PDF    Spanish   Russian   Chinese Coming soon in: Haitian-Creole, Korean, Italian


Comprehensive Formulary

Download PDF   Coming soon in: Spanish, Haitian-Creole, Korean, Italian, Chinese, Russian


Multi-language Insert

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Provider and Pharmacy Directory

CLICK HERE 


Medication Therapy Management Program (for eligible participants who opt in)

Download PDF 


 Out-of-Network Coverage Rules

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CMS Appointment of Representative Form (CMS Form-1696)

You can ask a friend, relative, your doctor or other provider, or another person to act for you as your “representative“ if you need assistance with a coverage determination, grievance, or appeal.  To give a friend, relative, doctor or other provider, or another person the right to be your representative, download and print a copy of the Appointment of Representative Form in your preferred language.  The form must be signed by you and the person whom you would like to act as your representative.  The completed and signed form must be provided to PHP Care Complete FIDA-IDD Plan and will be valid for 1 year.

Download PDF   SPANISH


 Coverage Determination Form (Part D)

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Coverage Redetermination Form (Part D)

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Prior Authorization Criteria (Part D)

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Step Therapy Criteria (Part D)

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Prescription Drug Transition Policy

Download PDF


Personal Medication List Form

Download PDF


Partners Notice of Change

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You can get this information for free in other languages. Call 1-855-747-5483, and 711 for TTY users, during the hours of 8:00 am to 8:00 pm, 7 days a week. The call is free.

Puede obtener esta información gratis en Español. Llame a Servicios del Participante al 1-855-747-5483 durante las horas de 8:00 am a 8:00pm, 7 días de la semana. Usuarios de TTY llamar al 711. La llamada es gratuita.

Lei puo ottenere questi informazioni in Italiano gratuitamente. Chiama il Servizio Partecipanti a 1-855-747-5483 durante il periodo da 8AM a 8PM, 7 giorni alla settimana. TTY utilizzatori dovressi chiamare 711. La chiamata è gratis.

Ou ka jwenn enfòmasyon sa a pou gratis nan kreyòl ayisyen. Rele sèvis patisipan nan 1-855-747-5483 les heures de 8:00 je pou 8:00 pm, 7 jou nan semenn nan. Utilisateurs TTY ta dwe rele 711. Apèl gratis.

Вы можете получить эту информацию бесплатно на русском языке. Звоните в Отдел обслуживания участников плана по телефону 1-855-747-5483 с 8:00 утра до 8:00 вечера, 7 дней в неделю. Пользователи TTY звоните по телефону 711. Звонок бесплатный.

您可免費獲得到以上的中文資訊, 請致電參與者服務電話 1-855-747-5483,辦公時間為上午8時到下午8時,每週7天。聽力語言殘障服務專線(TTY)用戶請撥打711。該電話為免付費通話。

한국어로 된 정보를 무료로 얻을 수 있습니다. 주 7일 오전 8시에서 오후 8시 사이에1-855-747-5483 번(TTY 사용자는 711번)으로 문의해 주십시오. 통화는 무료입니다.

You can get this information for free in other formats, such as large print, braille, or audio. Call 1-855-747-5483 and 711 for TTY users during the hours of 8:00 am to 8:00 pm, 7 days a week. The call is free.

This is not a complete list. The benefit information is a brief summary, not a comprehensive description of benefits. For more information contact the plan or read the Participant Handbook.

Limitations and restrictions may apply. For more information, call PHP Care Complete FIDA-IDD Plan Participant Services or read the PHP Care Complete FIDA-IDD Plan Participant Handbook.

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

Benefits may change on January 1 of each year.
GET HELP

Supporting the life you choose

Contact us at (855) PHP-LIVE  (747-5483) or TTY/TDD: 711

or
Visit the Online Help Center