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Hamaspik Medicare Choice(HMO D-SNP)
Get the best of both worlds
With comprehensive care you can count on
Enrolling now will bring you one step closer to Medicaid
and Medicare coverage in a single, all-inclusive plan.
Your prescription for better health
How Hamaspik makes getting your prescriptions a priority
Broad Formulary of Covered Medications
Each Hamaspik plan uses an established drug list (known as ‘The Formulary’) that has been approved by CMS (The Centers for Medicare and Medicaid Services). The drug list includes both brand name and generic drugs in all medication categories. Just speak with your doctor about the drugs you need, and show them the formulary for your plan.
Vast Pharmacy Network
You can get your medications at any of the thousands of pharmacies in our network, including all major drug store chains and many independent pharmacies. You can also order your medications to be delivered via mail.
Flexible Options
If you are taking a drug that is not included in the Hamaspik Medicare Select formulary, we will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new, and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication. The prescription must be filled at a network pharmacy. 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.
Prescription Drugs – Real Time Benefits Tool
You can learn more about the costs for your prescriptions by logging into the Prime Therapeutics member portal and using the Real Time Benefits Tool. The Tool allows you to find out about your out of pocket costs for the specific prescriptions that you take. Click on the link below to register and use the Tool.
Medication Therapy Management Program (MTMP)
Medication Therapy Management (MTM) is a service provided by pharmacists and other healthcare professionals to discuss all of your medications in detail.
The purpose of this program is to ensure the best possible outcomes for you, by reviewing and improving your use of medications. We accomplish this by increasing your knowledge about your medications and improving your understanding about your health conditions. Our pharmacists work with your physician(s) to ensure the benefits of participating in this program.
MTM services are not a standard Medicare benefit; you must qualify in order to participate.
To be enrolled in MTMP, individuals must meet the following criteria.
1
You have 3 or more of the following chronic illnesses, or are participating in the Hamaspik Drug Management Program:
- Alzheimer’s disease
- Diabetes Mellitus
- Dyslipidemia
- Hypertension
- Chronic Obstructive Pulmonary Disorder (COPD)
- Congestive Heart Failure (CHF)
- Arthritis/Osteoporosis
2
You take at least 8 ongoing medications to manage your chronic illnesses
3
You are likely to incur an annual cost of $1,623 or more for your prescription drugs (based on the cost of prescriptions you filled in the previous 3 months)
How MTMP Enrollment Works
Step 1
Engage
If you are found to be eligible for the MTMP, you will be automatically enrolled in the program. You will receive a welcome packet in the mail within the first 60 days of becoming eligible that explains how you can participate in the program. Additionally, you will receive a second offer by telephone inviting you to participate in the MTM program. If you do not wish to participate, or if you have questions about the program, please call us at 1-800-424-9342. (TTY users, please call 711.) Hours are 9:00 am to 7:00 pm, Monday to Friday.
Step 2
Review
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.
Step 3
Reflect
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. You will receive information on the safe disposal of prescription medications that are controlled substances. We encourage members to bring these documents to their physician visits to discuss the information provided.
Step 4
Reevaluate
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.
NOTE: Even if you do not participate in the MTM program, it is still a good idea to create a Personal Medication List to help you and your caregivers keep track of what medications you need to take. You can download and print a Personal Medication List here
Care that benefits you
Unlimited Access
Hamaspik Medicare Choice includes a broad range of services to keep you healthy and safe in your home. We cover all of the services you receive from your Medicare benefits, and many Medicaid benefits. With Hamaspik Medicare Choice, you receive your medical care and long term care services from one comprehensive health plan.
Vast Network
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, long term care providers, and their affiliated doctors.
Financial Support
As a member of a Hamaspik health plan, you are eligible for extra help in the form of a Low Income Subsidy (LIS), 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 with full LIS Coverage.
Make the most of your benefits
with these services from our partners
Over-The-Counter Health Items
Your membership in Hamaspik Medicare Choice includes coverage for Over-the-Counter (OTC) health products.
- Members may receive up to $215 per month in benefits.
- Hamaspik Medicare Choice covers all of the OTC products that are approved by Medicare.
- When you enroll, you will receive a pre-loaded debit card, which is valid for purchase at plan approved retail locations. Just activate the card by calling the toll-free number on the card, and you can start to use your benefits.
- You can use your benefits card at many local pharmacies and department stores.
- If you prefer, you can also order your OTC items online or by phone, and your purchase will be shipped to your home for no additional charge.
- Click here to review a list of the types of products that you can purchase.
Healthy Food and Produce Benefit
Hamaspik Medicare Choice is pleased to offer this special supplemental benefit for our members who have chronic illnesses. We want to offer this benefit because healthy food is especially important if you suffer from these medical conditions.
- Eligible members may use $75.00 per month of their “Over the Counter Health Product (OTC)” benefit, for the purchase of food and produce.
- When you enroll, you will receive a pre-loaded debit card, which is valid for purchase at plan approved retail locations. Just activate the card by calling the toll-free number on the card, and you can start to use your benefits.
- You can use your benefits card at many local stores.
- Click here to review a list of the types of products that you can purchase.
To determine if you are eligible for these benefits:
If you have been diagnosed with three or more chronic conditions (listed below), you may be eligible for the Healthy Food and Produce benefit. We will determine if you are eligible based on information provided by your physician(s) and your annual Health Risk Assessment. If you have questions about whether you are eligible for this benefit, please contact Member Services at 888-426-2774. (TTY users, call 711.)
Help with Your Utility Bills
Hamaspik Medicare Select can assist you with your monthly utility bills, including electric, gas, water, and phone services. This special supplemental benefit is available to our members who have chronic illnesses, because maintaining your connections to vital services is an important factor in keeping you healthy.
- Eligible members may use $75.00 per month of their “Over the Counter Health Product (OTC)” benefit to pay for your monthly utility expenses.
- When you enroll, you will receive a pre-loaded debit card, which can be used at your local utility provider to pay by mail, online, or in person.
- Just activate the card by calling the toll-free number on the card, and you can start to use your benefits.
Health & fitness services
Regular exercise is an important factor in remaining as healthy as possible. Your Hamaspik Medicare Select membership includes access to a wide selection of fitness options, provided by our partner “Silver and Fit.” Your fitness benefits include:
- Participation in one of our contracted gyms and fitness centers throughout the service area and nationally.
- Exercise classes, through live on-line classes and thousands of on-line videos.
- One home fitness kit, from a selection of wearable fitness trackers, weights, yoga equipment, pilates equipment, or swimming equipment.
- One-on-one unlimited coaching sessions by phone.
Click below to find out more, view your options, and choose the services that fit your lifestyle.
Quality assurance is ensured
Hamaspik 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.
Hamaspik Quality ImprovementMissing some paperwork?
Check out our Healthcare Resources Page,
or download the prescription form below:
Access to Your Health Information
As a member of a Hamaspik health plan, you can access current and up-to-date information about the health services that you receive. This is known as our Patient Access and Interoperability solution. This information uses new and innovative technology, in order to give you quick and secure access to your health care records on-line – on a smartphone, laptop, or tablet device.
Making this data available to you is based on requirements outlined in the CMS Final Rule, based on the 21st Century Cures Act that was passed by Congress in 2020. The type of information that is available includes:
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Claims for the services that you receive
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Clinical data about your health care services
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Your provider directory
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Your prescription drug formulary
Please note that the information that is available may include sensitive information such as information about your medical diagnoses, mental health and behavioral health services, alcohol and substance abuse, domestic violence, genetic testing, HIV/AIDS, reproductive health, pregnancy, abortion and sexually transmitted infections.
Core Elements
There are three core elements that work together in order to make this information available to you:
1) The Data Sources – Hamaspik health plans manages most of the data that is available to you. We also work with our providers to compile your data for certain services (like prescription drugs, and behavioral health services).
2) The Technology Stack – The data is then “formatted” and stored in the Fast Healthcare Interoperability Resources (FHIR) repository and so the data can be made available to members.
3) Third Party Applications – Hamaspik Members may download apps that can access this data to their smartphones, laptops or tablets. Members will need to create an account with one of the available API Gateway providers to allow the app togain access to his/her data.
Currently, there are two apps that are live and ready to connect you to your Hamaspik health plan data. You may find information on how to download and register with these apps below:
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OneRecord: https://onerecord.com/
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CareEvolution (myFHR app): https://careevolution.com/myfhr/
- B.well: (https://www.icanbwell.com/)
- Flexpa: (https://www.flexpa.com/)
- Health X Change: (https://www.healthxchange.us)
- mPowered: (http://www.mpoweredhealth.com/)
- ReimburseRPM: (https://reimburserpm.com/)
What is 1upHealth?
Hamaspik works with 1up Health as our contractor to make your data available to you. 1upHealth is a healthcare interoperability technology company, whose secure and reliable FHIR platform provides a complete view of member data. 1upHealth uses Touchstone, a product from Aegis, an independent third-party testing organization. Aegis is a member of the FHIR Business Alliance. Their Touchstone product integrates the latest health IT standards. Working with 1upHealth and Touchstone helps Hamaspik to ensure the environments that have your data will always meet the most current FHIR requirements.
Member Account Setup and Authorization Flow
In order to access your personal data, you must set up an account with one of the companies that offers an API Gateway. Members must set up an account when providing access to the first application with which they choose to share their data. Name, Date of Birth, Plan Member ID, Zip Code and a valid, unique email address are required.
After successful account creation, for future application access, Members will be prompted for the valid email address that was initially used to create the account. An authorization code will be sent to that email address and Members will be required to enter the code in order to authorize the access.
Member Rights and Risks
You have the right to share data with third-party app(s). You can grant consent to share your health data with any chosen third party app that is listed in the section above. When you submit your consent, we are required to make your health data available to you within one business day, through the third-party app that you select.
You have the right to revoke your consent at any time. If you decide that you want to stop accessing your data on the third-party app, this is also your right. You can immediately revoke the access granted to the app by calling Member Services, at the number on the back of your member ID card. (Also, please see the “Maintenance and Support” section below.)
You have the right to appoint an authorized personal representative. You may appoint a personal representative to act on your behalf. You can appoint anyone, such as a family member or a trusted aide, as your authorized personal representative to make health decisions on your behalf. Your appointed authorized personal representative is treated as the member and can grant, revoke or renew consent to the third-party apps to access your health data. In order to do this, you must complete and sign a form that gives your designated representative permission.
Please be careful when choosing who you want to appoint as your personal representative.
There is more information below about appointing a representative to access your data on your behalf. Click here to download the required form.
There are risks when you share your data with third party apps.
The apps that you can use to obtain your health records are not part of Hamaspik health plans. When you consent to share your data with of the available apps, we want you to also be aware of the potential risks lets you make an informed decision.
Allowing an app to access, store, manage or use your data involves some degree of risk. Through our relationship with 1upHealth, they have reviewed several apps and will only make an app available to you if it meets their quality and security standards. But once your data is shared externally and is controlled by a third party, Hamaspik has no visibility or control over how they store, manage or consume it.
If you think the safety of your data could be compromised by the third party, you can immediately stop sharing your data with them by calling Member Services, at the number listed below and on the back of your Member ID card.
Please note that Hamaspik takes every effort to safeguard your personal information when it is saved in our records. (Click here to download a copy of the Hamaspik privacy notice.)
However, when you authorize your data to be sent to you through a third party app, it is transferred outside of our records. You should review the privacy and security policies of the third party app to be sure that they are also protecting your data.
Risk of secondary usage of data by the third-party app(s). A specific example of risk to your data is called secondary usage. When your data is shared with a third-party app, they may use your data in other ways, such as for advertising. Please be sure to review their privacy policy and user agreement before you decide to share your data.
If you think the safety of your data could be compromised by the third party, you can immediately stop sharing your data with them by contacting Member Services at the number listed below and on the back of your Member ID card.
Risk of social engineering scams. Social engineering attacks, in which scammers try to access your health information, are becoming increasingly sophisticated. Beware of people or organizations posing as representatives of third-party health apps to trick you into sharing your sensitive information. Sometimes called “phishing scams,” these could be phone calls or emails pretending to be a trustworthy company or person requesting your information. There are some simple steps you can take to protect your information:
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Keep your anti-virus software updated at all times.
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Use multifactor authentication for important accounts.
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Don’t respond to requests for personal information or passwords.
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Don’t open email from a suspicious source.
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Don’t click on links or open attachments received in an email from a suspicious or unknown sender.
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Don’t use the same password for multiple accounts.
Appointing a Representative
An authorized personal representative is a person allowed to act on your behalf to make health decisions for you. Before someone can act as an authorized personal representative, you must appoint them by providing a legal document called Power of Attorney (POA) or Health Care Proxy. If you need assistance with these documents, please consult an attorney. Your care manager can also provide you with the official New York State Health Care Proxy form.
Medicare and Medicaid require that we treat your authorized personal representative the same as we would treat you, regarding the information we share and decisions that are made about your care. That means we would honor the health decisions your representative makes on your behalf (just like we would honor yours). Because of this, you should be careful in choosing who you want to appoint as your authorized personal representative.
Your authorized personal representative is treated like you, the member, in terms of health decisions they can make and has rights that include:
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Making health decisions on your behalf
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Granting, revoking and renewing consent to third-party apps on your behalf
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Viewing the list of third-party app(s) that are accessing your health data
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Accessing your health data via the third-party app(s)
However, you can also restrict your authorized personal representative from seeing certain protected health information, such as information about substance abuse treatment, mental health services, and HIV.
How to appoint an authorized personal representative
To submit a request for appointing an authorized personal representative, follow these steps:
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You must complete and sign a form that gives your designated representative permission. Click here to download the required form.
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As a next step, you need to mail or email the signed authorization form to your Hamaspik Health Plan.
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You can email it to us at info@hamaspik.com
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You can mail it to us at:
Hamaspik Health Plans
58 Route 59, Suite #1
Monsey, NY 10952
You can fax it to us at: 845-503-0999
We will review the form to be sure it is complete, and we will contact you if we have any questions. Upon successful approval, the authorized personal representative will receive an email from us with a unique access code to set up a new account or link their existing account to the personal representative role.
Note: You also have the right to terminate an authorized personal representative at any time.
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If you want to replace your authorized rep with somebody new, submit an updated authorization form to us, as outlined above.
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If you want to revoke, submit a revocation letter, you must notify us in writing. You can send this notice to us at the address or email or fax number outlined above.
If you have questions, please contact Member Services at 888-426-2774. (TTY users, call 711.)
Problem with your coverage?
If you have a concern about your healthcare or would like to file a complaint about your Hamaspik plan, 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 as an appeal. You can file a grievance in writing, over the phone, via fax or email. You can find detailed information about grievances and appeals in your Evidence of Coverage document.
1-888-426-2774
For TTY/TDD services, call 711
Hamaspik Medicare Choice
Attn: Grievances and Appeals775 N Main St.Spring Valley, NY 10977
quality@hamaspik.com
Fax: 1-845-503-0999
You can also file grievances with CMS by calling 1-800-MEDICARE, or online at
https://www.medicare.gov/my/medicare-complaint
You can file a grievance with the New York State Department of Health by calling 1-866-712-7197.
Please contact Member Services if you would like to obtain information about the aggregate number of grievances, appeals and exceptions that have been filed with your Hamaspik healthcare plan.
What to expect
After you file a grievance, Hamaspik 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
The next steps
We will investigate your concern, and will notify you of our decision within 30 days. (or within 24 hours for expedited grievances). If we choose to contest your complaint, you will be notified. Our response will include reasons for our course of action.
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.
Coverage decisions
Hamaspik Medicare Choice 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.
Coverage decisions are only made by qualified physicians. When we make a coverage decision about your Medicare-covered services, we look at several important factors. First, we review the information submitted by you or your provider to confirm the service you are requesting is appropriate for somebody based you your diagnoses or other medical criteria. We also need to ensure that your services are approved for as long as they are medically necessary to avoid disruptions in your care. We make coverage decisions based on Medicare laws and guidelines, national coverage determinations (NCD), and local coverage determinations (LCD), when available. If this type of information is not available, we utilize Interqual clinical criteria to assist in our decision making. However, please note that the clinical criteria are used for guidance only; coverage decisions are always made by a physician. (Click here to learn more about Interqual clinical criteria.)
If you wish to request approval for a drug that is not included in the Hamaspik Medicare Select formulary, this is called an "exception request." Your doctor will need to provide us with information about why you need to take the drug that you are requesting. You may also appeal any coverage determination, if you disagree with our decision.
If you have a question about how to ask for a service to be authorized, or how to file an appeal, we also encourage you to contact Member Services. Please call 888-426-2774. (TTY users, call 711.) Or send your request in writing to:
Hamaspik Medicare Choice
58 Route 59, Suite #1
Monsey, NY 10952
How to appeal
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 appeal 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, and it is reviewed by Hamaspik Medicare Choice. If we deny your appeal, we will automatically forward it for a Level 2 appeal, which is reviewed by an independent third party. In some circumstances, other levels of appeal are also available.
Getting help
For assistance with filing a coverage decision or grievance, or appeal, contact us. 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 on our
Alternative Options
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 visiting https://www.medicare.gov/my/medicare-complaint
You can file a grievance with the New York State Department of Health by calling 1-866-712-7197. If you need assistance requesting a coverage decision or filing a grievance or an appeal, we also encourage you to contact Member Services. Please call 888-426-2774. (TTY users, call 711.)
Hamaspik Medicare Choice
Attn: Care Management
58 Route 59, Suite 1
Monsey, NY 10952
Participant Ombudsman
The Participant Ombudsman, called the Independent Consumer Advocacy Network (ICAN), is an independent organization that provides free ombudsman services to long term care recipients in the state of New York. You can get free independent advice about your coverage, complaints, and appeal options. They can help you manage the appeal process.
They can also provide support before you enroll in a MAP plan like Hamaspik Medicare Choice. This support includes unbiased health plan choice counseling and general program related information.
Contact ICAN to learn more about their services:
- Phone: 1-844-614-8800 (TTY users, please call: 711)
- Web: www.icannys.org
- Email: ican@cssny.
org
Notice of Non-Discrimination
Hamaspik Choice complies with Federal civil rights laws. Hamaspik Choice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (as defined in 45 CFR § 92.101(a)(2)).
Hamaspik Choice provides the following:
• Free and services to people with disabilities to help you communicate with us, such as:
○ Qualified sign language interpreters
○ Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Free language services to people whose first language is not English, such as:
○ Qualified interpreters
○ Information written in other languages
If you need these services, call Hamaspik Choice at 855-552-4642. For TTY/TDD services, call 711.
If you believe that Hamaspik Choice has not given you these services or treated you differently because of race, color, national origin, age, disability, or sex, you can file a grievance with Karl Dehm, Vice President, Compliance and Regulatory Affairs, by:
Mail: 775 North Main Street, Spring Valley, NY 10977
Phone: 1-855-552-4642
For TTY/TDD services, call 711
Fax: 1-845-503-1900
In person: 775 North Main Street, Spring Valley, NY 10977
Email: compliance@hamaspikchoice.org
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
We never stop caring for you
For assistance with any of the following,
contact our dedicated member service team 1-888-426-2774, For TTY/TDD services, call 711,
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… and more
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Get the care you need, the information you want,
and your questions answered—all here on our site.
and your questions answered—all here on our site.
Hamaspik Medicare Choice is a Medicare Advantage and Prescription Drug Plan (HMO D-SNP) with a Medicare contract, and a Medicaid Advantage Plus (MAP) plan with a New York State contract. Enrollment in Hamaspik Medicare Choice depends on contract renewal. This information is not a complete description of benefits. For a complete list of covered services and other important information, please review the Evidence of Coverage.
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