給 您 和 您 家 人 的 照 護 QUEST 會 員 手 冊
歡 迎 加 入 OHANA! Ohana QUEST Medicaid Ohana Medicaid (PCP) PCP PCP 10-11 Ohana 1-866-924-0277 (TTY/TDD: 1-877-247-6272) www.ohanahealthplan.com
OHANA 您 的 健 康 計 劃 目 錄..........................................................5 Ohana.................................................... 5................................................................. 6..................................................... 6 OHANA................................................................... 7................................................. 10 ID.......................................... 10 PCP..................................................................... 10 PCP......................................................................10 (PCP)...........................................................11 PCP..................................11 24................................................... 12...................................................................12 /............................................................ 12 Ohana..................................................13.............................................................. 14........................................................ 14.................................................................... 15................................................................ 15....................................................................... 16....................................................................39.................................................................. 39............................................................ 39................................................... 39..................................................... 39.................................................................... 39.......................................................... 39..................................................... 39..............................................40...................................................40 (OTC)................................................................40 OTC....................................................40 1 www.ohanahealthplan.com
.................................................................... 41................................................... 41....................................................... 41 DMR............................ 41.......................................................... 41..................................................... 41......................................... 41......................................................................... 42......................................................................... 43......................................................................... 43.........................................................................44.....................................................44.........................44................................................... 45 Ohana................................................................. 45................................................................ 46..................................................................46...............................................46........................................46................................................................46.................................................................... 47....................................................................48....................................................48....................................................................48.....................................................48...................................................................49...................................................49.................................................50................................................................50...........................................................50....................................................................... 51..............................................................52 /.......................................................... 52................................................................ 53.................................................................. 53 (WIC).................................................... 53 歡 迎 加 入 Ohana 2
EPSDT........ 54....................................................... 54................................................ 55.............................................. 55......................................... 55......................................... 55..................................... 55................................................................ 56 21...............................................56................................................................ 61...................................................................... 65.............................................................65...............................................65..............................................65................................................65...................................................65.....................................65........................................................ 66.................................................................66............................................................66 QUEST............................................................ 67.................................................................... 67.................................................................68............................................................68.......................................68.........................................69............................................69......69.........................................................................70..................................70............................................70.....................................70......................................... 71.......................................................... 71....................................... 71 3 www.ohanahealthplan.com
OHANA....................................................72.................................................................. 72...................................... 72............................................. 72.................................................................... 72........................................................... 73....................................................................... 73..............................................................73..............................................................77 歡 迎 加 入 Ohana 4
我 們 在 這 裡 提 供 幫 助 OHANA 7:45 5:30 ID 1-866-924-0277 (TTY/TDD: 1-877-247-6272) Customer Service Plaza at Mill Town 94-450 Mokuola Street, Suite 106 Waipahu, HI 96797 TTY/TDD 1-877-247-6272 24 5 www.ohanahealthplan.com
24 1-800-919-8807 TTY/TDD 1-877-247-6272 (Logisticare) 1-866-790-8858 Logisticare 1-866-481-9699 1-866-924-0277 (TTY/TDD: 1-877-247-6272) (CCMC) 1-866-486-8030 (Advantica) 1-866-924-0277 (TTY/TDD: 1-877-247-6272) (HearUSA) 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 1-866-924-0277 (TTY/TDD: 1-877-247-6272) Hawai i MED-QUEST 1-800-316-8005 PCP www.ohanahealthplan.com 歡 迎 加 入 Ohana 6
OHANA 字 典 Ohana EPSDT (HMO) 7 www.ohanahealthplan.com
Hawai i 24 Ohana PCP Med-QUEST (MQD) Medicaid QUEST QExA Ohana ID ID (OTC) 歡 迎 加 入 Ohana 8
(PDL) Ohana (P&T) Ohana (PCP) QUEST (FPL) QUEST (QExA) (ABD) PCP WIC 9 www.ohanahealthplan.com
如 何 從 您 的 計 劃 中 獲 取 最 多 1. ID Ohana ID Medicaid ID (PCP) Ohana 2. PCP PCP 10 www.ohanahealthplan.com PCP 15 PCP PCP PCP PCP OB/GYN PCP 3. PCP PCP www.ohanahealthplan.com 歡 迎 加 入 Ohana 10
PCP 10 10 ID ID PCP www.ohanahealthplan.com 4. (PCP) PCP PCP PCP PCP PCP ID PCP PCP / (OB/GYN) PCP PCP 5. PCP Ohana PCP www.ohanahealthplan.com Ohana ID Ohana 11 www.ohanahealthplan.com
ID PCP 6. 24 24 7 24 1-800-919-8807 / 911 7. 911 8. / 7:45 5:30 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 1 Customer Service Plaza at Mill Town 94-450 Mokuola Street, Suite 106 Waipahu, HI 96797 歡 迎 加 入 Ohana 12
Ohana Ohana 9. Ohana 73 13 www.ohanahealthplan.com
使 用 承 保 的 服 務 PCP 30 60 15 60 24 60 7 24 24 PCP 72 PCP 4 21 45 Hawai i 歡 迎 加 入 Ohana 14
承 保 的 服 務 PCP Medicaid Ohana 38 Ohana Medicaid 15 www.ohanahealthplan.com
QUEST 24 - - - - - - - 7 24 歡 迎 加 入 Ohana 16
LAAM / - - - 46 46 17 www.ohanahealthplan.com
46 7 24 46 46 Hawai I QUEST 歡 迎 加 入 Ohana 18
(CCMC) CCMC 1-866-486-8030 46 (FFS) 19 www.ohanahealthplan.com
46 PCP 46 歡 迎 加 入 Ohana 20
/ / / 3 46 6 46 60 4 2 21 www.ohanahealthplan.com
(PDL) 歡 迎 加 入 Ohana 22
X 46 // 46 46 21 23 www.ohanahealthplan.com
21 46 42 35 46 歡 迎 加 入 Ohana 24
Hawai i 46 21 2 24 Advantica 25 www.ohanahealthplan.com
24 (ADL) (IADL) 60 歡 迎 加 入 Ohana 26
Keiki QUEST 24 - - - - - - - 7 24 LAAM / - - - 46 27 www.ohanahealthplan.com
Keiki 46 7 24 46 歡 迎 加 入 Ohana 28
Keiki 46 Hawai i QUEST (CCMC) CCMC 1-866-486-8030 46 21 Med-QUEST (FFS) CCMC 29 www.ohanahealthplan.com
Keiki 46 歡 迎 加 入 Ohana 30
Keiki PCP 46 / 1-3 4-4 / / 3 46 6 46 31 www.ohanahealthplan.com
Keiki 4 2 (PDL) 歡 迎 加 入 Ohana 32
Keiki X 46 // 46 46 21 33 www.ohanahealthplan.com
Keiki 42 35 46 Hawai i 46 歡 迎 加 入 Ohana 34
Keiki 21 Advantica 21 / 35 www.ohanahealthplan.com
Keiki 24 (ADL) (IADL) 歡 迎 加 入 Ohana 36
/ DOH HRS 706 37 www.ohanahealthplan.com
/ Ohana ACS // IgG4 Hawai i (SHOTT) DHS / SHOTT 歡 迎 加 入 Ohana 38
處 方 與 藥 房 使 用 處 方 藥 服 務 www.ohanahealthplan.com Ohana ID Medicaid 首 選 藥 物 列 表 Ohana (PDL) PCP (CDR) PDL www.ohanahealthplan.com PDL PDL DESI 39 www.ohanahealthplan.com
非 處 方 (OTC) 藥 物 OTC Ohana OTC OTC H-2 / OTC 歡 迎 加 入 Ohana 40
直 接 會 員 理 賠 DMR Ohana Health Plan Reimbursement Department P.O. Box 31577 Tampa, FL 33631-3577 DMR a. b. c. DMR DMR 41 www.ohanahealthplan.com
(NET) NET NET NET O ahu Handi Handi O ahu Handi Handi Handi Handi The First Insurance Center, 1100 Ward Ave., Suite 835, Honolulu, HI 96814-1613 8:30 4 1-808-538-0033 Handi NET 歡 迎 加 入 Ohana 42
NET 72 72 72 NET Logisticare NET 1-866-790-8858 NET Ohana (RN) PCP 1-866-924-0277 TTY/TDD 1-877-247-6272 Ohana 43 www.ohanahealthplan.com
1-866-924-0277 TTY/TDD 1-877-247-6272 49 PCP / / PCP Ohana 911 ID PCP 24 48 PCP Medicaid 歡 迎 加 入 Ohana 44
OHANA Ohana PCP 45 www.ohanahealthplan.com
如 何 獲 得 服 務 PCP PCP PCP PCP EPSDT 21 Ohana Ohana ID www.ohanahealthplan.com PCP PCP 歡 迎 加 入 Ohana 46
www.ohanahealthplan.com PCP 14 14 24 (UM) / 47 www.ohanahealthplan.com
UM 1-866-924-0277 TTY/TDD 1-877-247-6272 Ohana 90 PCP PCP PCP PCP PCP PCP 24 1-800-919-8807 12 911 911 PCP 24 歡 迎 加 入 Ohana 48
(ER) Ohana ID PCP ER ER Hawaii ID PCP Ohana 49 www.ohanahealthplan.com
PCP 24 PCP 24 PCP Ohana Medicaid ID PCP Ohana EPSDT 21 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 30 DHS 15 QExA 15 Ohana QUEST 30 QUEST 歡 迎 加 入 Ohana 50
Ohana OB 14 PCP Ohana Health Plan Ohana PCP Ohana Ohana 51 www.ohanahealthplan.com
基 於 社 區 的 服 務 Hawai i / Ohana PCP (WIC) (CAMHD) / Ohana 21 Central O ahu Pearl City 453-5900 Family Court Liaison Branch Kailua 269-9922 Honolulu Honolulu 733-9393 Leeward O ahu Kapolei 692-7700 Windward K ne ohe K ne ohe 233-3770 Hawai i Hilo Waimea Kona Hilo Kamuela Kona 933-0610 887-8100 322-1541 Kaua i L hu e 274-3883 231 Maui Wailuku L hain L na i Moloka i Wailuku L hain L na i City Kaunakakai 243-1252 662-4045 565-7915 553-5067 歡 迎 加 入 Ohana 52
Medicaid Hawai i (DDD) DDD DD/MR 586-5840 Honolulu, O ahu 241-3406 L hu e, Kaua i 243-4625 Wailuku, Maui 974-4280 Hilo, Hawai i Ohana EPSDT 21 EPSDT (The Zero to Three Program) Hawai i Keiki 1-800-235-5477 O ahu, 1-808-594-0066 (DOE) DOE 1-808-586-3230 1-808-586-3232 (WIC) 1-888-820-6425 O ahu 586-8175 (WIC) WIC WIC 53 www.ohanahealthplan.com
健 康 兒 童 照 護 和 EPSDT( 早 期 和 定 期 篩 檢 診 斷 與 治 療 ) 服 務 Ohana EPSDT 21 EPSDT EPSDT Medicaid PCP PCP 歡 迎 加 入 Ohana 54
PCP 3 5 1 2 4 6 9 12 15 18 2 6 6 20 PCP 55 www.ohanahealthplan.com
預 防 健 康 指 南 PCP PCP PCP PCP PCP 90 PCP 21 * (HepB) 3 5 * (HepB) 48 1 2 * (HepB) (TB) * (DTaP) (RV) (IPV) (PCV) b (Hib) 歡 迎 加 入 Ohana 56
4 6 9 12 15 18 * DTaP Hib IPV PCV RV (Hgb) * DTaP HepB IPV PCV RV TB * / * 9 Hib (MMR) (HepA) 12 23 PCV 12 15 ** 6 TB * DTaP 15 18 * (HepA) 6 TB 57 www.ohanahealthplan.com
24 3 4-5 * TB * TB 12 24 * 4 5 5 DTap IPV MMR 12 24 TB 歡 迎 加 入 Ohana 58
6-20 11-12 13-14 13-17 18-20 21 * 6 10 12 15 18 6 8 10 9 (HPV) * (MCV) (Tdap) HPV (STI) * 18 21 (STI) * MCV4 16 Tdap * * 0 9 / BMI 0 24 3 ** 6 59 www.ohanahealthplan.com
PCP A1c (HbA1c) 7 (LDL) LDL 100 / 2010 / (www.aap.org) Vol. 105 (3) 2000 645 646 AAP 2000 0 18 2010 (ACIP) http://www.cdc.gov/vaccines/recs/schedules/childschedule.htm#printable (AAP) (AAFP) 4 18 1-2009 (www.cdc.gov/nip/acip/) 2008 / (www.aap.org) (www.aafp.org) (www.ada.org) 2/2010 歡 迎 加 入 Ohana 60
90 30 21 64 18 (BMI) 18 21 1 2 PCP 35 65 45 65 (TC) / (HDL) (TC) / (HDL) 5 5 20 (TC) / (HDL) 5 16 25 12 21 64 3 40 X 1 2 61 www.ohanahealthplan.com
50 10 2 65 60 2 65 - (Td/Tdap) 19 Td 1 Tdap 10 Td (VZV) 2 1 (MMR) (PPSV) (HepA) (HepB) 1957 1-2 65 1 50 18 3 歡 迎 加 入 Ohana 62
(MCV) 18 MCV 1 56 (HPV)* b (Hib) 26 3 60 1 Hib 1 40 50 X (PSA) 40 75 PCP 18 50 1,000 50 1,200 1,500 0.4 (NTD) 4 (STD) (HIV) 63 www.ohanahealthplan.com
20072007 2006 6 29 2010 III 2001 5 2004 Cleveland (www.cchs.net/health/health-info) ACG 2008 * Ohana Ohana 2/2010 歡 迎 加 入 Ohana 64
預 先 指 示 90 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 65 www.ohanahealthplan.com
Office of Health Care Assurance 1250 Punchbowl St. Honolulu, Hawai i 96813 (808) 586-4400 (808) 586-4444 會 員 申 訴 與 上 訴 程 序 / / 1-866-924-0277 (TTY/TDD: 1-877-247-6272) Ohana Health Plan Attn: Grievance Department P.O. Box 31384 Tampa, FL 33631-3384 歡 迎 加 入 Ohana 66
30 QUEST QUEST QUEST Hilopa a O ahu 1-808-791-3467 Hawai i 1-808-333-3053 Maui and L na i 1-808-270-1536 Moloka i 1-808-660-0063 Kaua i 1-808-240-0485 ombudsman@hilopaa.org 1-808-531-3595 www.hilopaa.org 30 MQD Med-QUEST Division Health Care Services Branch P.O. Box 700190 Kapolei, HI 96709-0190 O ahu: 1-808-692-8094 (TTY: 1-808-692-7182) 1-800-316-8005 (TTY: 1-800-603-1201) 30 67 www.ohanahealthplan.com
/ 30 1-866-924-0277 (TTY/TDD: 1-877-247-6272) Ohana Health Plan Attn: Appeals Department P.O. Box 31368 Tampa, FL 33631-3368 30 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 7:45 5:30 1-866-201-0657 72 歡 迎 加 入 Ohana 68
14 14 30 Hawai i Med-QUEST State of Hawai i Department of Human Services Administrative Appeals Office P.O. Box 339, Honolulu, HI 96809 90-10 - 69 www.ohanahealthplan.com
Ohana Health Plan Attn: Pharmacy Medication Appeals Department P.O. Box 31398 Tampa, FL 33631-3368 1-888-865-6531 30 Ohana Health Plan Attn: Pharmacy Medication Appeals Department P.O. Box 31398 Tampa, FL 33631-3398 1-888-865-6531 30 歡 迎 加 入 Ohana 70
30 14 72 14 71 www.ohanahealthplan.com
關 於 OHANA 的 重 要 信 息 Ohana Kaua i Moloka i L na i O ahu Maui Hawai i PCP MQD 1-800-316-8005 1-866-924-0277 (TTY/TDD: 1-877-247-6272) Ohana Ohana 歡 迎 加 入 Ohana 72
/ Ohana ID 24 1-866-678-8355 www.ohanahealthplan.com Ohana 會 員 權 利 與 責 任 73 www.ohanahealthplan.com
Medicaid FFS - - 歡 迎 加 入 Ohana 74
- 30 PCP - - (DHS) - DHS - 75 www.ohanahealthplan.com
Ohana Health Plan 1. 120 DHS 2. 3. 90 PCP PCP ID Medicaid ID ID Ohana PCP PCP PCP 48 Ohana 1-866-924-0277 (TTY/TDD: 1-877-247-6272) 歡 迎 加 入 Ohana 76
WELLCARE 2010 15 WellCare of Florida, Inc. HealthEase of Florida, Inc. WellCare of New York, Inc. WellCare of Connecticut, Inc. WellCare of Louisiana, Inc. WellCare of Georgia, Inc. WellCare of Ohio, Inc. WellCare of Texas, Inc. WellCare WellCare Health Plans of New Jersey, Inc. Harmony Health Plan of Illinois, Inc. WellCare Prescription Insurance, Inc. WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois, Inc. WellCare Health Insurance of New York, Inc. WellCare Specialty Pharmacy, Inc. WellCare 1. 77 www.ohanahealthplan.com
2. Medicare Medicaid (i) (ii) (iii) 歡 迎 加 入 Ohana 78
3. 1. (i) (ii) (iii) 1988 (CLIA) (EHR) EHR EHR 30 60 EHR EHR (1) (2) (3) 2. 60 3. (i) (ii) (iii) (iv) (v) (vi) (vii) 79 www.ohanahealthplan.com
60 4. 5. 6. (www.wellcare.com) 7. www.wellcare.com 1. 1-866-530-9491 www.wellcare.com WellCare Health Plans, Inc. Attention: Privacy Officer P.O. Box 31386 Tampa, FL 33631-3386 2. 3. HIV/AIDS WellCare Health Plans 歡 迎 加 入 Ohana 80
1-866-924-0277 (TTY/TDD: 1-877-247-6272) www.ohanahealthplan.com 47459 HI018073_CAD_MHB_CHI State Approved 05302012 WellCare 2012 HI_02_12