...appeal. Refer to the plan’s Evidence of Coverage (Chapter 9) for information about how to ask for an appeal. The DMP may not apply to members that have certain medical...

...as outpatient x-rays. This information is not a complete description of benefits. View Chapter 4 Medical Benefits (what is covered) of your Evidence of Coverage (EOC) on the Plan Documents...

...covered services. If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us. Tell your doctor and other...

...formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive...

...Preferred Drug List (PDL) for July 1-September 30, 2022 is available here. Notification Date Posted Summary of Drug Coverage Changes Effective October 1, 2024 08/13/2024 Summary of Drug Coverage Changes...

...providers using guidelines from the Indiana Office of Medicaid Policy and Planning (OMPP) and the National Committee for Quality Assurance (NCQA).CareSource credentials providers using guidelines from the Indiana Health Coverage...

...care service. Plan – This is the health coverage you get through CareSource The HHW program covers children up to age 19 and some pregnant women. There is little or...

...guide the provision of clinical care to beneficiaries. CPGs do not create new benefits or coverage rules and shall not supersede or replace the requirements of the TRICARE Policy Manual,...

...your Evidence of Coverage (EOC) for more information about how drugs are included or not included on your Formulary. We want to make sure our members get the safest, most...

...of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of individual members or payment claims included in the bundled complaint or appeal....