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Introduction

Welcome to
Hamaspik Medicare Select

Hamaspik Medicare Select (HMO D-SNP) is a Medicare Advantage Special Needs plan that serves dual eligible members. ‘Dual eligible’ is a term referring to those individuals who qualify for both Medicare and Medicaid.

A Medicare Advantage Special Needs plan offers you a different way to receive your Medicare services through a private, Medicare-approved insurance company. Our plan includes care managers and a member services team who are ready to provide comprehensive support.

Our plan covers everything that Medicare covers, plus additional benefits including Part D prescription drugs, vision benefits and over-the-counter health products—all with $0 premium! Finally, these benefits are covered in one health plan called Hamaspik Medicare Select.


Enrolling in
Hamaspik Medicare Select

You are eligible to enroll in Hamaspik Medicare Select if you meet the following requirements:

- You are entitled to Medicare Parts A and B due to your age or disability

- You are eligible for Medicaid benefits in the State of New York

- You live in our service areas in

  • Albany
  • Bronx
  • Columbia
  • Greene
  • Kings (Brooklyn)
  • Montgomery
  • Nassau
  • New York (Manhattan)
  • Orange
  • Putnam
  • Queens
  • Rensselaer
  • Richmond (Staten Island)
  • Rockland
  • Schenectady
  • Dutchess
  • Sullivan
  • Ulster
  • Westchester

3 ways to enroll

Call Hamaspik
Medicare
Select

01

Call Hamaspik Medicare Select

Once you have verified that you meet the eligibility requirements listed above, call us toll free, and a licensed sales representative can help you enroll.

Our staff are available to come to your home to explain the benefits of Hamaspik Medicare Select and determine your eligibility. If you choose to enroll, they can also help you complete the application form.

*Note: After March 31, 2020, hours will be
Monday through Friday, 8:00am to 8:00pm

Mail us your
application

02

Mail us your<br> application

If you choose, you can print and mail us your enrollment application. Click the link below to download the form and send us a completed copy.

Link to Enrollment Application

We will contact you once your application has been processed. In most cases, your enrollment will be effective on the first day of the month following the date you signed the enrollment form. If you have a question or need assistance, feel free to contact Member Services.

Enroll
through CMS

03

Mail us your<br> application

Medicare beneficiaries can also enroll in Hamaspik Medicare Select through the CMS Medicare Online Enrollment Center via their website. Follow the link to explore options and find important contact information.

CMS site:

www.medicare.gov

Contact

Hamaspik Member
Services

If you need assistance, our dedicated Member Services Department can help.

Call us between the hours of 8:00am and 8:00pm, 7 days a week, or leave a message after-hours with our answering service, and someone will be in touch.

phone

1-833-426-2774

TTY/TDD users call 711

Give us a call to:

Understand the services that are covered by your Hamaspik health plan

Resolve a concern you are having about your healthcare services

Find a provider or change your PCP

Replace a lost ID card

Get a referral

Make a complaint or give us positive feedback

Answer a question about a process or status update

Coverage

How to Get Benefits & Services

When you enroll in Hamaspik Medicare Select, you have access to all of the doctors, healthcare professionals, medical groups, hospitals and healthcare facilities that are part of the Hamaspik Medicare Select network.

An important first step is to choose a Primary Care Physician (PCP). Your PCP is your main healthcare provider and arranges for you to receive preventive care and other routine medical services. He or she also coordinates your benefits, helps you manage your ongoing health concerns, and teaches you to make healthy lifestyle choices. If you need a specialist, your PCP can connect you to a local in-network doctor.

Our provider network includes hundreds of physicians in every county within our service area, covering your primary care needs plus a wide range of specialists. The network also features many of New York’s leading hospital systems and their affiliated doctors.

Hamaspik Medicare Select

Covered services:

Visits to your primary care physician and specialists

Inpatient and outpatient hospital care

Emergency and urgent care

Ambulance services

Home health services

Durable medical equipment

Mental health services (inpatient and outpatient)

24-hour nurse hotline

Outpatient diagnostic tests and therapeutic services/supplies

Outpatient rehabilitation services including physical therapy, occupational therapy and speech/language pathology

Over-the-counter health items

Part D prescription drugs

Skilled nursing facility care

Vision benefits including eye exams and eyeglasses

And more!

For a complete list of services covered, please review your Evidence of Coverage by clicking the links below. These resources include detailed information about all your benefits as well as information about any coverage limits or authorization requirements.

Prescription Drug Coverage

Hamaspik Medicare Select includes your Medicare prescription drug coverage (also known as Medicare Part D). Please review the following information.

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Our plan uses an established drug list (known as ‘The Formulary’) that has been approved by CMS. The drug list includes both brand name and generic drugs in all medication categories. Please speak with your doctor about the drugs you need, and show them the Hamaspik Medicare Select Formulary.

Formulary
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You may get your medications at thousands of pharmacies in our network including all major drug store chains and many independent pharmacies, so there is always a location conveniently close to home. You can also order your medications to be delivered via mail.

Prescription Drug Transition Policy
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If you are taking a drug when you enroll in Hamaspik Medicare Select, and that drug is not covered by our plan, you may continue to receive your medication for at least one month. This will ensure that your health needs are always met. Be sure to talk with your doctor during this time to prescribe a different drug or to file an exception request.

Exception Request Form

Prescription Drug Forms


Medication Therapy Management Program

Hamaspik works with Magellan Rx Management, a pharmacy benefit manager, to provide our Medication Therapy Management Program (MTMP). This program is a free service for all eligible members, and although it is voluntary, we encourage you to participate. You will receive notification of eligibility within 60 days of enrollment.


MTMP eligibility criteria

  1. You take at least 5 ongoing medications to manage your chronic illnesses
  2. You are likely to incur an annual cost of $4,255 or more for your prescription drugs (based on the cost of prescriptions you filled in the previous 3 months)
  3. You have certain chronic illnesses that are common among Medicare beneficiaries, especially if you have 3 or more of the following diagnoses:
    • Alzheimer’s disease
    • Diabetes Mellitus
    • Dyslipidemia
    • Hypertension
    • Chronic Obstructive Pulmonary Disorder (COPD)

A key component of the program is the Comprehensive Medication Review (CMR), which you will complete with one of our pharmacists during a telephone consultation. The CMR typically takes between 15 and 30 minutes. During that time, the pharmacist will answer any questions you have about your medications, the best time to take them, and more.

After the conversation is complete, a written summary of the discussion will be sent to you within 14 days. The written summary will include a letter, personal medication list and medication action plan. We encourage members to bring these documents to their physician visits to discuss the information provided.

In addition to CMR, members who participate in MTMP will be included in various Targeted Medication Reviews (TMRs) conducted throughout the year on a quarterly basis. TMRs use pharmacy claims data to assess eligible members’ medication profiles for medication-related issues or gaps in care. Any recommendation that is identified through the TMR will be sent to your physician so they may assess it during your next visit.

If you are found to be eligible for the MTMP, you will be automatically enrolled in the program. If you do not wish to participate, notify us at any time by calling 1-800-424-9342, and we will remove you from the MTMP. Hours are 9:00am to 5:00pm, Monday to Friday.

Personal Medication List

Low Income Subsidy

As a member of Hamaspik Medicare Select, you may be eligible for extra help in the form of a Low Income Subsidy, which helps you pay for your prescription drugs and copayments. Regardless of your income, all members receive the same high quality of care provided through our plan. However, you must continue to pay your Part B premium.

Resources

Member Rights, Responsibilities
& Important Documents

Hamaspik works with Magellan Rx Management, a pharmacy benefit manager, to provide our Medication Therapy Management Program (MTMP). This program is a free service for all eligible members, and although it is voluntary, we encourage you to participate. You will receive notification of eligibility within 60 days of enrollment.

Member Rights & Responsibilities

Member Resources

Follow the link for the required Hamaspik Medicare Select
Enrollment Form.


Your Summary of Benefits includes information on what services are covered by Hamaspik Medicare Select and other important information about the Plan.


Your Evidence of Coverage includes detailed information about your Medicare-covered health benefits and prescription drug coverage.


Hamaspik Medicare Select has a wide range of participating pharmacies in our plan network. Use the locator tools to view a list of national pharmacy chains or to find a pharmacy that is close to your home


The Formulary is a list of prescription drugs, including brand name and generic drugs, prescribed by practitioners to help their patients. Hamaspik Medicare Select covers all the prescription drugs included in the document.


Hamaspik Medicare Select covers a number of health items at no cost to you. Browse the OTC Product List and use the OTC Order Form to make a purchase under the plan.


Do you need someone to file an appeal or complaint for you? If so, use the Appointment of Representative Form to designate an Authorized Representative. This individual can help you with matters related to your healthcare needs.



Follow the link for the Low Income Subsidy premuim summary chart.


Our Privacy Notice details important information about patient confidentiality per HIPAA Privacy Rules.


Hamaspik Medicare Select complies with federal civil rights laws and does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. We also provide the following:

  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats and more)
  • Free language translation services to people whose first language is not English, such as qualified interpreters and information written in other languages

If you need services, contact Member Services. Or, if you believe Hamaspik has not given you these services or has treated you differently for any reason, you can file a grievance with Hamaspik:

Mail: Hamaspik Medicare Select Attention: Grievances and Appeals 58 Route 59, Suite 1 Monsey, NY 10952

In person: at the address listed above

Phone: 1-833-426-2774
For TTY/TDD services, call 711

Fax: 1-845-503-0999

Email: quality@hamaspik.com


You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights via:

Web: OCR Complaint Portal at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Mail: U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F,
HHH Building
Washington, DC 20201

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Phone:

1-800-368-1019
For TTY/TDD, call 800-537-7697


Language Assistance Services

English

English

Spanish

Spanish

Chinese

Chinese

Arabic

Arabic

Korean

Korean

Russian

Russian

Italian

Italian

French

French

French Creole

French Creole

Yiddish

Yiddish

Polish

Polish

Tagalog

Tagalog

Bengali

Bengali

Albanian

Albanian

Greek

Greek

Urdu

Urdu

ATTENTION: Language assistance services, free of charge, are available to you. Call: 1-855-552-4642. TTY/TDD: 1-855-854-4030.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-552-4642. TTY/TDD: 1-855-854-4030

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-855-552-4642. TTY/TDD 1-855-854-4030.

اتصل برقم ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. TTY/TDD 1-855-854-4030. > (رقم هاتف الصم والبكم1-855-552-4642.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-855-552-4642. TTY/TDD: 1-855-854-4030. 번으로 전화해 주십시오.

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-855-552-4642. (телетайп: TTY/TDD 1-855-854-4030).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-855-552-4642. TTY/TDD 1-855-854-4030.

ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-855-552-4642. TTY/TDD 1-855-854-4030.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-855-552-4642. TTY/TDD 1-855-854-4030.

רופט אויפמערקזאם: אויב איר רעדט אידיש, זענען פארהאן פאר אייך שפראך הילף סערוויסעס פריי פון אפצאל. 1-855-552-4642. TTY/TDD 1-855-854-4030.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-855-552-4642. TTY/TDD 1-855-854-4030.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-552-4642. TTY/TDD 1-855-854-4030.

লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। ফোন করুন ১ 1-855-552-4642. TTY/TDD 1-855-854-4030.

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-855-552-4642. TTY/TDD 1-855-854-4030.

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-855-552-4642. TTY/TDD 1-855-854-4030.

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں . TTY/TDD 1-855-854-4030.

Complaint process

Grievances & Appeals

If you have a concern about your health care or would like to file a complaint about Hamaspik Medicare Select, please contact Member Services within 60 days of the problem. We want to understand your concerns and help you to resolve them. Depending on the situation, your case will be handled as a grievance (or complaint) or an appeal. You can file a grievance or complaint in writing, over the phone, via fax or email.

(You can find detailed information about grievances and appeals in your Evidence of Coverage.)

Mail: Hamaspik Medicare Select Attention: Grievances and Appeals 58 Route 59, Suite 1 Monsey, NY 10952

Phone: 1-833-426-2774 For TTY/TDD services, call 711

Fax: 1-845-503-0999

Email: quality@hamaspik.com

Please contact Members Services if you would like to obtain information about the aggregate number of grievances, appeals and exceptions that have been filed with Hamaspik Medicare Select.

You can also file you Grievance about Hamaspik Medicare Select with CMS, by calling 1-800-MEDICARE, or online at the Medicare.goc complaint website at: medicare.gov

After you file a grievance, Hamaspik Medicare Select looks carefully into your case and will seek to resolve the problem right away. We will respond with the following:

  • The person who is working on your complaint
  • The contact information for this individual
  • Any additional information we will need to investigate your complaint
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We will notify you of our decision and reasoning within 30 days of when we have all the necessary information to answer your complaint (or within 24 hours for expedited grievances). If we do not agree with some or all of your complaint, or refuse to take responsibility for the problem, we will let you know. Our response will include reasons for this answer.

You will be informed on how to appeal a decision and will be provided any necessary forms. If we are unable to make a decision about your complaint due to missing information, we will also notify you.

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To appeal a decision about your health care services, please follow these guidelines:

  • File an appeal within 60 business days of receiving our decision
  • File the appeal yourself or ask someone you trust to file the complaint on your behalf
  • Make sure the complaint is made in writing (even if you initially call, you must follow up in writing)
  • - Your first appeal is referred to as a Level 1 appeal; if you disagree with our determination, you may go on to a Level 2 appeal, which is reviewed by an independent third party. In some circumstances, other levels of appeal are also available
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If you are not satisfied with the services you have received from Hamaspik, you (or someone on your behalf) may submit a complaint directly to Medicare by calling 1-800-MEDICARE or 1-800-633-4227. Or you can file your grievance with Medicare on-line by using the following link: https://www.medicare.gov/MedicareComplaintForm/home.aspx.

If your service request has been denied, we also encourage you to contact Member Services. There are many times when a member may ask Hamaspik Medicare Select to approve a treatment or service in the form of an exception request. To get approval, call 833-426-2774 or send your request in writing:
Hamaspik Medicare Select
Attention: Care Management
58 Route 59, Suite 1
Monsey, NY 10952

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Hamaspik Medicare Select makes a coverage decision every time we decide what services are covered and how much we will pay. You or your doctor can also contact us to request a coverage decision if you are unsure if a particular medical service is included in your plan. You may also appeal this determination.

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For assistance with filing a coverage decision or appeal, contact Hamaspik Medicare Select Member Services. Your doctor, prescriber or lawyer can also submit a request on your behalf at any point in the appeals process, including requests for Part D prescription drugs. Alternatively, you may appoint a friend, relative or another representative via the Appointment or Representative form above.

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Quality Assurance Policies & Procedures

Hamaspik Medicare Select has programs in place to ensure our members always receive safe, appropriate care. We are committed to providing the highest caliber of healthcare services; therefore, we have created a Quality Improvement program aimed at maintaining this focus. For more information, please review the link below.

Search

Finding a Provider

Hamaspik Medicare Select contracts with various providers, doctors and pharmacies who share our values of respect, excellence and the provision of high-quality care. These professionals make your healthcare a priority and pledge to honor the unique cultures and traditions of our diverse member base.

Find a Provider / Pharmacy
Find a Covered Drug

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