Amendment to Evidence of Coverage
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Notifies Scripps Health Plan HMO members of updates to the Evidence of Coverage (EOC) document that clarify benefits, member responsibilities, and access-to-care information; affects Scripps Health Plan HMO members.
Addition of the Summary Benefit Description grid which outlines your member responsibility for common services.
Additional language regarding the Calendar Year Out-of-Pocket Maximum and Calendar Year Medical Deductible.
Clarification of the Family Planning Services and Infertility Services benefits.
Addition of the 'Timely Access to Care' section, which informs you of your rights regarding timeframes for an appointment for PCP, Specialist, Behavioral Health and Ancillary care services.
Clarification of the Exclusions and Limitations section so you can better understand which services are covered and which services are excluded from coverage.
Updated the Notice of Nondiscrimination and Availability of Language Services.
Amendment Highlights & Coverage Summary
Amendment highlights
Summary statements in the amendment; full coverage details are in the updated Evidence of Coverage and Summary of Benefits and Coverage documents.
ALL of the following
- Addition of the Summary Benefit Description grid which outlines member responsibility for common services.
- Additional language regarding the Calendar Year Out-of-Pocket Maximum and Calendar Year Medical Deductible; see the EOC for specific amounts and calculations.
- Clarification of the Family Planning Services and Infertility Services benefits; see the EOC for details.
- Addition of the 'Timely Access to Care' section describing members' rights and appointment timeframes for PCP, Specialist, Behavioral Health and Ancillary services.
- Clarification of the Exclusions and Limitations section to better understand covered and excluded services.
- Updated Notice of Nondiscrimination and Availability of Language Services.
Coding and Cost-share Updates
| No codes listed |
Required Actions for Members and Providers
Timely Access to Care (Member Rights)
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