Your Responsibilities

Below are things you need to do as a member of the plan. If you have any questions, please call Member Services (phone numbers are printed on the back cover of this handbook).

  • Get familiar with your covered services and the rules you must follow to get these covered services. Use this handbook to learn what is covered, and the rules you need to follow to get your covered services.
  • Chapters 3 and 4 give the details about your health care services, including what is covered by the plan, what is not covered, and rules to follow.
  • Chapter 7 provides details about prescription drug coverage, including what you may be required to pay.
  • To be covered by AmeriHealth Caritas New Hampshire, you must receive all of your health care from the plan’s network providers except:
  • Emergency care;
  • Urgently needed care when you are traveling outside of the plan’s service area;
  • Family planning services; and
  • When we give you authorization in advance to get care from an out-of-network provider.
  • If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell AmeriHealth Caritas New Hampshire as soon as possible. Please call Member Services to let us know (phone numbers are printed on the back cover of this handbook).

We are required to follow rules set by Medicaid to make sure that you are using all of your coverage. This is called “coordination of benefits” because it involves coordinating the health and prescription drug benefits you get from our plan with any other health and prescription drug benefits available to you. We will help you coordinate your benefits. For more information about coordination of benefits, refer to Section 1.5 (How other insurance works with our plan).

  • Tell your doctor and other health care providers that you are enrolled in our plan. Show your plan membership card and your New Hampshire Medicaid card whenever you get your covered services, including medical or other health care services and prescription drugs.
  • Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
  • To help your doctors and other health care providers give you the best care, learn as much as you are able to about your health conditions. Give your health care providers the information they need about you and your health. Follow the treatment plans and instructions that you and your doctors agree upon.
  • Make sure your doctors and other health care providers know all of the drugs you are taking, including over-the-counter drugs, vitamins, and supplements.
  • Talk to your PCP about seeking services from a specialist before you go to one, except in an emergency.
  • Keep appointments, be on time, and call in advance if you are going to be late or have to cancel your appointment.
  • Authorize your PCP to get necessary copies of all of your health records from other health care providers.
  • If you have any questions, be sure to ask. Your doctors and other health care providers will explain things in a way you can understand. If you ask a question and you do not understand the answer you were given, ask again.
  • Request interpretation services if you need them. Our plan has staff and free language interpreter services available to answer questions from non-English speaking members. If you are eligible for New Hampshire Medicaid because of a disability, we are required to give you information about the plan’s benefits that is accessible and appropriate for you at no cost. For more information, refer to Section 2.13 (Other important information: Alternative formats and interpretation services).
  • Respect other members, plan staff and providers. For information about when members may be involuntarily disenrolled for threatening or abusive behavior, refer to Section 11.2 (When you may be involuntarily disenrolled from the plan).
  • Pay what you owe. As a plan member, you are responsible for these payments, as applicable:
    • For prescription drugs covered by the plan, you must pay a copayment, if required. However, any inability to pay your copayment does not prevent you from getting your prescription filled. Refer to Chapter 7 (Getting covered prescription drugs) to learn what you must pay for your prescription drugs.
    • If you get any health care services or prescription drugs that are not covered by our plan or by other insurance you have, you are responsible for the full cost.
    • If you disagree with our decision to deny coverage for a health care service or prescription drug, you can request an appeal. For information about how to request an appeal, refer to Chapter 10 (What to do if you want to appeal a plan decision or “action”, or file a grievance).
  • Tell the plan if you move. If you are going to move or have moved, it is important to tell us as soon as possible. Call Member Services (phone numbers are printed on the back cover of this handbook).
  • Do not allow anyone else to use your AmeriHealth Caritas New Hampshire or New Hampshire Medicaid membership cards. Refer to Section 2.12 (How to report suspected cases of fraud, waste, and abuse). Notify us when you believe someone has purposely misused your health care benefits.
  • Call Member Services for help if you have questions or concerns. We also welcome any suggestions you may have for improving our plan. (Phone numbers for Member Services are printed on the back cover of this handbook).
Members