Member Information - Health Choice Generations (2024)

Getting the care you need

Please take the time to review your benefits. The Evidence of Coverage will give you details about your Medicare health care and prescription drug coverage.

The Summary of Benefits will give you a summary of what we cover and what you pay. Please note, it does not list every service that we cover or list every limitation and exclusion. Please review your Evidence of Coverage for a complete list of services we cover.

If you would like a printed copy of the Evidence of Coverage or Summary of Benefits, or if you have questions about your benefits, please call Customer Service at 844-457-8943 (TTY, 711), 8 a.m. – 8 p.m., 5 days a week (April – September) and 7 days a week (October – March).

Over-the-Counter Items

As a member of Health Choice Generations Utah (HMO D-SNP), you have a combined $125 monthly allowance for Over-the-Counter (OTC) items and, if eligible, healthy foods through your Special Supplemental Benefits for the Chronically Ill (SSBCI) Grocery benefit. If a member does not qualify for the SSBCI grocery benefit, the $125 monthly allowance will apply to the OTC only. Be sure to use your benefit amount before the end of every month as unused allowance does not carry over to the next month. The benefits mentioned are a part of the Special Supplemental Benefits for the Chronically Ill. Not all members qualify.

Items may be ordered over the phone at 1-833-432-3703 (TTY 711) Monday – Friday 9 a.m. – 5 p.m. or online at https://healthybenefitsplus.com/HealthChoiceGenerations and shipped to your home.

Translation Services

Health Choice Generations Utah recognizes we have members of different cultures and backgrounds. These members might need special assistance such as translation services or having a doctor that speaks another language.

In addition, if you should need assistance translating the information on the Health Choice Generations site or would like to receive Health Choice Generations in an alternative format such as another language or larger print, please contact Customer Service at 844-457-8943 (TTY, 711), 8 a.m. – 8 p.m., 5 days a week (April – September) and 7 days a week (October – March).

Hearing Impaired Services

Hearing-impaired members of Health Choice Generations can call Relay Utah at 888-346-3162 or dial 711 to reach an operator who will connect them to Relay Utah. There is no cost for the service.

Rights & Responsibilities

As a recipient of Medicare and as a member of Health Choice Generations Utah, you are entitled to certain rights and also share certain responsibilities with us which are explained below.

You have the right to:

• Be treated with Fairness and Respect
• The Privacy of your Medical Records and Personal Health Information (PHI)
• See plan providers, get covered services, and get prescriptions filled within a reasonable period
• Know your treatment choices and participate in decisions about your healthcare
• Use Advance Directives, such as a Living Will or Power of Attorney
• Make complaints
• Get information about your healthcare coverage and costs
• Get information about Health Choice Generations Utah, plan providers, or your prescription drug coverage

How to get More Information About Your Rights

If you have questions or concerns about your rights and protections, please call Health Choice Generations Utah Customer Service at844-457-8943(TTY,711), 8 a.m. – 8 p.m., 7 days a week, or you may receive free help and information from:

Aging & Adult Services
Utah Department of Health and Human Services
195 N. 1950 W.
Salt Lake City, Utah 84116

In addition, the Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) 24 hours a day/7 days a week. Or you can visit the Medicare website at www.medicare.gov to order this booklet or print it directly from your computer.

To learn more about your rights and responsibilities upon disenrollment, please review the Evidence of Coverage document.

What can you do if you think you have been treated unfairly or Your Rights are not being respected?

If you think you have been treated unfairly or your rights have not been respected, what you should do depends on your situation. If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. Or, you can call the Office for Civil Rights in your area at:

Rocky Mountain Region States (including Utah)
1961 Stout Street, Room 08-148
Denver, CO 80294
Toll-free: 1-800-368-1019
Toll-free TDD: 1-800-537-7697

For any other kind of concern or problem related to your Medicare rights and protections described in this section, you can call Customer Service at844-457-8943(TTY,711), 8 am – 8 pm, 7 days a week.

Your Responsibilities as a Member of Health Choice Generations Utah

As a member of Health Choice Generations Utah, you also have responsibilities.

Your responsibilities include the following:

To get familiar with your coverage and the rules you must follow to obtain care as a member. You may use your Evidence of Coverage and Summary of Benefits, as well as other information we provide to you to learn about your coverage, what you have to pay, and the rules you need to follow. Please call Health Choice Generations Utah Customer Service at 844-457-8943(TTY,711), 8 a.m. – 8 p.m., 7 days a week if you have any questions.

To give your doctor and other providers the information they need to care for you, and to follow the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your doctors and other providers if you have any questions.

To act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals, and other offices.

To pay any co-payments you may owe for the covered services you receive. You must also pay for any other financial responsibilities you may incur.

Let us know if you have any questions, concerns, problems, or suggestions.

Fraud, Waste, and Abuse

What are Fraud, Waste, and Abuse?

FRAUD is any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/her or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

WASTE is unintentional misuse of Medicare funds through inadvertent error, most frequently incorrect coding and billing.

ABUSE (of member) means provider practices inconsistent with sound fiscal, business, or medical practices, resulting in an unnecessary cost to the health plan, or in reimbursem*nt for services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes recipient practices that result in unnecessary costs to the health plan.

For potential Fraud-Waste-Abuse complaints, you may call our Hotline

Examples of fraud, waste, and abuse include letting someone use your ID card to get medical care; a provider who bills for services that you did not receive; getting a prescription that was not prescribed by a licensed and appropriate medical provider; and/or a medical provider physically abusing a Health Choice Generations Utah member.

All organizations that provide Medicare Advantage Plans, like Health Choice Generations Utah, must obey federal laws against retaliation. If you report fraud, waste, and abuse to Health Choice Generations Utah, it will not affect the medical care you receive.

If you witness any misuse of any ID card, or any other instances of Medicare fraud, waste, or abuse, please contact Health Choice Generations Utah FWA Alertline, toll-free at 1-877-898-6080 or TTY 711. You can call this number any time and leave a confidential message.

Please leave a detailed message regarding the reason for your call and the following information:

• Your name – please state whether you are a member, provider, or employee of Health Choice Generations Utah. If you are a member or provider, please provide your Health Choice Generations Utah plan ID number.
• Telephone number.
• The best time to reach you.

You may remain anonymous. Your call will receive the same attention whether you identify yourself or not.

Reporting Services Not Provided
Identity Theft Prevention
Prevent Fraud When Changing Plans
Online Pharmacies Fraud Preventions

Appointment of a Representative

Sometimes, people need assistance to help them make decisions, ask questions, or to help them interpret the rules and regulations of a plan. If this happens, you have the right to ask someone such as a family member or friend to help you with decisions about your healthcare.

The “Appointment of Representative” is a form to give someone you trust, the legal authority to make decisions for you about claims, organization determinations, reconsiderations, and other appeals and grievances, should you be unable to make decisions for yourself.

If you decide that you want to appoint someone to speak on your behalf, please fill out the form below and mail or fax your form to:

Health Choice Generations Utah
PO Box 45900
Salt Lake City, UT 84145
Fax: 480-760-4635

Note:
Please make sure you make a copy and retain it for your records before mailing or faxing it to Health Choice Generations Utah.

If you have further questions about appointing someone to speak or make healthcare decisions on your behalf, contact Health Choice Generations Utah Customer Service at844-457-8943(TTY,711), 8 a.m. – 8 p.m., 7 days a week.

Appointment of Representative Form (Rev 08/2018)
Appointment of Representative Form – Spanish (Rev 08/2018)

Authorization to Disclose Personal Health information (PHI)

Health Choice Generations Utah will only disclose the personal health information you want to be disclosed. This form can be used if you want Health Choice Generations Utah to give your personal health information to someone other than yourself.

If you decide that you want to appoint someone who we can disclose personal health information on your behalf, please fill out the form below and mail or fax your form to:

Health Choice Generations Utah
PO Box 45900
Salt Lake City, UT 84145
Fax: 480-760-4635

Note:
Please make sure you make a copy and keep it for your records before mailing or faxing it to Health Choice Generations Utah.

If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call Health Choice Generations Utah Customer Service at844-457-8943(TTY,711), 8 a.m. – 8 p.m., 7 days a week.

Authorization for Use or Disclosure of PHI form (Effective 11-04-2021)
Authorization for Use or Disclosure of PHI form – Spanish (Effective 11-04-2021)

Advance Directives

As an adult, you can express your wishes about the type of medical treatment you would like to have through a document known as an Advance Medical Directive for Healthcare.

Simply stated, it provides directions in the event of an accident or illness which results in your inability to communicate your wishes yourself. An Advance Directive can also allow you to designate a person (a proxy) who will make healthcare decisions for you.

An advance directive may be used to accept or refuse any procedure or treatment, including life-sustaining treatment. You should discuss your options with your physicians, loved ones, clergy, and/or close friends.

There are different types of advanced directives and different names for them. Documents called “Living Will” and “Power of Attorney for Healthcare” are two examples.

If you decide that you want to have an Advance Directive, there are several ways to get this type of form; from your lawyer, a social worker, or some office supply stores. To make it easier for our members, Health Choice Generations Utah Utah has posted the Living Will and Power of Attorney for Healthcare forms along with instructions on how to fill out the form.

If you should have any questions, please call Health Choice Generations Utah Customer Service at844-457-8943(TTY,711), 8 a.m. – 8 p.m., 7 days a week.

Instructions for Completing the Health Care Directive or Writing a Living Will

1. 1. Print your name on the first blank line. “I, MY NAME, want everyone who cares for me to know what health care I want when I cannot let others know what I want.”
   2. Think about the statement, “A quality of life that is unacceptable to me means” and check each item from the list below that applies. You may add any words you want on the blank lines to further describe the conditions when you would not want to continue to receive treatment.
   3. This means that if you are in the condition described, you would want your family and doctors to stop or withdraw treatment. You would not want to continue to live in that condition.
   4. Think about the statement, “There are some procedures that I do not want under any circ*mstances.”
   5. If you have decided that you would never want a treatment listed, check that box. If you have not decided yet, or if you would want your doctor to try these treatments, leave the box blank.
   6. Think about the statement, “When I am near death, it is important to me that.” When writing a living will, you can write anything you like on these lines. Some people say, “I want hospice care.”, “I want to die at home.”, or “I want my family near me.” You may leave these lines blank if you wish.

1. You must sign this form on the reverse side and you must have your signature witnessed.
2. The witness cannot be related to you by blood, marriage, or adoption, cannot be a beneficiary to your estate, and cannot be directly involved in your healthcare.
3. After writing a living will give a copy of it to your Health Care (Medical) Power of Attorney, to your family and close friends, and your doctor. Keep a copy to take to the hospital or clinic if you become ill and need treatment.

Health Care Directive

Instructions for Completing the Health Care (Medical) Power of Attorney

1. Print your name in the first blank line.
2. “I, MY NAME, as principal, designate . . .
3. Print the name of the person you have chosen to be your Health Care (Medical) Power of Attorney on the next blank line.
4. “OTHER PERSON’S NAME, as my agent for all matters relating to my health care . . . “
5. Print the address and phone number of the person you have chosen to be your Health Care (Medical) Power of Attorney on the next blank line.
6. “Print agent ADDRESS and PHONE”
7. You may name an alternate person to be your Health Care (Medical) Power of Attorney. This second person would take over if the first person you named is not available or is unable to make decisions for you.
8. “If my agent is unwilling or unable to serve or continue to serve, I at this moment appoint SECOND PERSON’S NAME as my agent.”
9. If you choose a second person as an alternate, complete the next blank line with the second person’s address and phone number. If you do not choose a second person as an alternate, leave this last line blank.
10. You must sign this form in front of a witness.
11. The witness cannot be related to you by blood, marriage, or adoption, cannot be a beneficiary to your estate, and cannot be directly involved in your healthcare.