Member Handbook
The purpose of this section is to establish the responsibility of providers to notify new enrollees and all health plan enrolled Members receiving health care services about the availability of Member handbooks.
The Health Plan Member Handbook is intended to provide information to Members and potential enrollees regarding the availability of services in the public health care system. The Health Plan Member Handbook provides information regarding how to obtain services, what services are available, what service limitations exist for Title XIX and Non-Title XIX persons, ACC members, and Member rights and responsibilities, among other topics. This information is imperative in verifying that services are accessible.
The Health Plan produces the Member Handbook. It is printed in a typestyle and size which can easily be read by Members with varying degrees of blindness or low vision, such as large print and other alternative formats included but not limited to audio and/or Braille.
Member handbooks will be made available to Health Plan members upon enrollment. Members will receive notification of how to obtain a handbook in accordance with timelines in AHCCCS ACOM Policy 400 Chapter 406. The notification will be provided within the member welcome packet.
Upon request, copies must be made available to Member and family advocacy organizations and other human service organizations. Provider must have a process in place to monitor the delivery of the Member Handbook to its members.
Persons receiving services have the right to request and obtain a Member Handbook at least annually. The Health Plan is required notify persons of their right to request and obtain a Member Handbook at least annually by publishing this information using Health Plan communications such as the health plan webpage, newsletter, welcome packet, etc.
AHCCCS may require the Health Plan to revise the Member Handbook and distribute it to all current enrollees if there is a significant program change. AHCCCS determines if a change qualifies as significant.
Member Handbooks are reviewed annually, and if needed, updated by AHCCCS and the Health Plan. Any approved revisions or updated versions of the Member Handbook will be posted to the Health Plan website by the effective date of such revisions or updates. Providers can help members obtain the Member Handbook by referring the member to the Health Plan website.