Certificate of Coverage

Pro Care Health Plan, Inc.

MEDICAID

CERTIFICATE OF COVERAGE

Pro Care Health Plan, Inc.

3956 Mount Elliott

Detroit, Michigan 48207


Pro Care Health Plan, Inc. is a licensed health maintenance organization. Pro Care is a for-profit corporation whose business office is at 3956 Mount Elliott Street, Detroit, Michigan 48207.  Pro Care is accredited by the Utilization Review Accreditation Commission.


                                                                                                        ARTICLE 1 - GENERAL CONDITIONS

1.1              CertificateThis Certificate of Coverage is issued to you because you are eligible for the Medicaid Program and you are enrolled in Pro Care Health Plan (“Pro Care ”).  If you are the head of the house and others in your house are also enrolled in Pro Care this Certificate is issued to you as the head of the house.  In this Certificate you are called the “Member”.  Others in your house who are also enrolled in Pro Care are also called the “Member”.

1.2              Rights and Responsibilities.  This Certificate describes and states the Member’s rights and responsibilities and Pro Care’s rights and responsibilities.  It is the Member’s responsibility to read and understand this Certificate.  By enrolling in Pro Care, the Member agrees to comply with this Certificate.

1.3              Changes.  All changes to this Certificate must be in writing and signed by an authorized officer of Pro Care.  Verbal changes to this Certificate are not permitted even if an employee of Pro Care tells the Member differently.

1.4              Assignment.  The Member’s rights to receive Covered Services under the Certificate are personal to the Member.  The Member may not give or sell these rights to any other person.  If the Member gives or sells, or tries to give or sell, his or her rights to any other person, the Member’s enrollment in Pro Care  may be terminated under Article 9.

                                                                                                                             ARTICLE 2 - DEFINITIONS

2.1              “Applicability”  This part of the Certificate tells the meaning of words that are used throughout this Certificate.  If a word is defined in this part of the Certificate, that word has the same meaning throughout this Certificate.

2.2              “CAHCP” means Child and Adolescent Health Centers and Programs.

2.3               “Certificate” means this Certificate of Coverage between Pro Care and the Member, and all changes and attachments to this Certificate.

2.4               “Communicable Diseases” means HIV/AIDS, sexually transmitted diseases, tuberculosis and vaccine-preventable communicable diseases.

2.5              “Contract Year means a 12-month period ending on an anniversary of the Member’s effective date of coverage.

2.6              “Copayment means the amount of money that the Member is required to pay directly to a Participating or Non-Participating Provider for certain Covered Services.

2.7              “Covered Servicesmeans the Medically Necessary services, equipment and supplies set forth in Appendix A of this Certificate which are covered health care benefits under this Certificate.

2.8              “Department means the Michigan Department of Community Health or its successor agency which is duly authorized to administer the Medicaid Program in the State of Michigan.

2.9              “Emergency Medical Conditionmeans a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent lay person, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in (i) serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child; (ii) serious impairment of bodily functions; or (iii) serious dysfunction of any bodily organ or part.

2.10          “Emergency Services means the services which are Medically Necessary to treat an Emergency Medical Condition.  Emergency Services includes medical screening exams and stabilization consistent with the federal Emergency Medical Treatment and Active Labor Act.

2.11          “Experimental means a supply, drug, device, item, procedure or treatment that meets one of more of the following standards:

A.                It cannot be lawfully marketed without the approval of the Food and Drug Administration (FDA) and such approval has not been granted at the time of its use or proposed use.

B.                 It is the subject of a current investigational new drug or new device application on file with the FDA.

C.                 It is being provided pursuant to a Phase I or Phase II clinical trial.

D.                It is being provided pursuant to a written protocol which describes among its objectives the determination of safety, efficacy or efficiency in comparison of conventional alternatives.

E.                 It is being delivered or should be delivered subject to the approval and supervision of an Institutional Review Board as required and defined by federal regulations, particularly those of the FDA or the Department of Health and Human Services (HHS) or successor agencies, or of a human subjects or comparable committee.

F.                  The predominant opinion among experts as expressed in the published authoritative literature is that usage should be substantially confined to medical investigational or research settings.

G.                The predominant opinion among experts as expressed in the published authoritative medical or scientific literature is that further experiment, investigation or research is necessary in order to define safety, toxicity, effectiveness or efficiency compared with conventional alternatives.

H.                At the time of its use or proposed use, it is not routinely or widely employed or is otherwise not generally accepted by the medical community.

I.                   It is not investigative in itself pursuant to any of the foregoing criteria, and would not be Medically Necessary, but for the provision of a drug, device, treatment, procedure or equipments which meets any of the foregoing criteria.

J.                   It is deemed experimental, investigational or research under Pro Care’s insurance or reinsurance agreements.

An antineoplastic drug which is a covered benefit in accordance with Section 3406e of the Insurance Code is not an Experimental drug.

2.12          “Family Planning Services are any medically approved diagnostic evaluation, drugs, supplies, devices, and related counseling for the purpose of voluntarily preventing or delaying pregnancy or for the detection or treatment of sexually transmitted diseases.

2.13          “Health Professional means an individual licensed, certified or authorized in accordance with Michigan law to practice a health profession in Michigan.

2.14          “Hospital means a facility licensed as a hospital under Michigan law, except for a facility licensed or operated by the State of Michigan as a mental health or psychiatric hospital.

2.15          “Hospital Services mean those Covered Services which are provided by a Hospital.

2.16          “Insurance Code means the Michigan Insurance Code of 1956, as amended, MCL 500.101 et seq.

2.17          “Medicaid Contract is the contract between the Department and Pro Care under which Pro Care agrees to arrange for Covered Services for Members.

2.18          “Medicaid Programmeans the medical assistance program established by Michigan and federal law to provide comprehensive health care services for eligible individuals.

2.19          “Medical Director means a Physician designated by Pro Care to supervise and manage the quality of care aspects of Pro Care’s programs and services.

2.20          “Medically Necessary means the services, equipment or supplies necessary for the diagnosis, care or treatment of the Member’s physical or mental condition as determined by the Medical Director in accordance with accepted medical practices and standards of care at the time of treatment.  Medically Necessary does not in any event include any of the following:

A.                services rendered by a Health Professional that do not require the technical skills of the Health Professional; or

B.                 services, equipment or supplies furnished mainly for the personal comfort or convenience of the Member, any individual who cares for the Member, or any individual who is part of the Member’s family; or

C.                 that part of the cost of service, equipment or supply which exceeds that of any other service, equipment or supply that would have been sufficient to safely and adequately diagnose or treat the Member’s physical or mental condition, except when rendered by, or provided upon the referral of, a PCP, or otherwise authorized by Pro Care, in accordance with Pro Care ’s procedures.

2.21          “Medicare means the health benefits program primarily for elderly and disabled individuals established under Title XVIII of the federal Social Security Act, 42 U.S.C. 1395 et seq.

2.22          “Member means a Medicaid Program beneficiary enrolled in ProCare and on whose behalf the Department has paid a Premium in accordance with the Medicaid Contract.

2.23           “Non-Covered Service means a health care service which is not a covered health care benefit under this Certificate.

2.24          “Non-Participating Provider means a Health Professional, a Hospital, pharmacy, laboratory, or any other health care provider or supplier who does not have a contract with ProCare to render Covered Services to Members.

2.25          “Office of Insurance means the Michigan Office of Financial and Insurance Services, or its successor agency, which is duly authorized to regulate health maintenance organizations in Michigan.

2.26          “Participating Hospital means a Hospital, which has a contract with ProCare to provide Covered Services to Members.

2.27          “Participating Physician means a Physician who has a contract with ProCare to provide Covered Services to Members.

2.28          “Participating Provider means a Participating Physician, Participating Hospital, or any other Health Professional or health care provider or supplier which has a contract with ProCare  to render Covered Services to Members.

2.29          “PCP means the Participating Provider who is responsible for providing primary care Covered Services for the Member and arranging and coordinating all aspects of the Member’s health care.

2.30          “Physician means a doctor of allopathic or osteopathic medicine licensed to practice medicine in the State of Michigan.

2.31          “Pro Care means Pro Care Health Plan, Inc. a Michigan for profit corporation licensed by the State of Michigan as a health maintenance organization.

2.32          “Premium means the amount of money paid by the State of Michigan to Pro Care to secure Covered Services for Members under the Medicaid Contract.

2.33          “Service Area means the geographic area in which Pro Care is authorized by the Office of Insurance and Department to operate as a health maintenance organization and Medicaid health plan.

2.34          “Specialist means a Participating Physician, other than a PCP, who provides Covered Services to Members upon referral by the PCP and, if required, prior authorization by Pro Care.

2.35          “Urgent Care means the treatment of a medical condition that requires prompt medical attention but is not an Emergency Medical Condition.

                ARTICLE 3 - ELIGIBILITY, ENROLLMENT AND EFFECTIVE DATE OF COVERAGE

3.1              Eligibility.  The Department has sole authority to determine the eligibility of individuals or families for the Medicaid Program.  Pro Care does not have any authority to determine whether an individual is eligible for the Medicaid Program.

3.2              Enrollment.  An individual may enroll in Pro Care only if the individual is eligible for the Medicaid Program and lives within the Service Area.  The Department or its Enrollment Services Contractor has sole authority for enrolling individuals in Pro Care .  An eligible individual may choose Pro Care, or the Department may choose Pro Care for the eligible individual.  Pro Care will not deny enrollment to, expel, or refuse to re-enroll any individual because of the individual’s health status or need for services.

3.3              Effective Date of Coverage.  The effective date of the Member’s coverage by Pro Care  is the first day of the month after the Department notifies Pro Care in writing of the enrollment.  However, if the Member is in any inpatient setting on this date, Pro Care is not responsible for arranging or paying for any health care services for the Member, including the inpatient stay and any charges connected with that stay.  Pro Care is responsible only for arranging and paying for Covered Services after the date of the Member’s discharge from the inpatient setting.  Pro Care is not responsible for arranging or paying for any health care services for an individual before the effective date of coverage in Pro Care, except for newborns as set forth below.  Pro Care is not responsible for arranging or paying for any health care services for an individual during a period of retroactive eligibility (as determined by the Department), except for newborns as set forth below.   Pro Care or the Department will notify the Member of the effective date of enrollment in ProCare and coverage under this Certificate.

3.4              Newborns.  The Member’s newborn child is eligible for the Medicaid Program for the month of birth, and may be eligible for up to one-year longer as determined by the Department.  The newborn child is automatically enrolled in Pro Care if the child’s mother is eligible for the Medicaid Program and is enrolled in Pro Care at the time of the child’s birth. The newborn is entitled to Covered Services retroactive to the date of birth.  The Member must notify the Member’s Michigan Department of Human Services caseworker as soon as possible after the birth of a newborn.  The Department has sole authority to determine the continued eligibility and enrollment of a newborn.

3.5              Change of ResidenceThe Member must notify Pro Care when the Member moves to a residence outside of the Service Area.  If the Member moves outside of the Service Area, the Member’s enrollment in Pro Care may be terminated under Article 9.  However, the Member is entitled to Covered Services until the Member is disenrolled from Pro Care. The Member must notify Pro Care either by telephoning or writing to the Member Services Department. Pro Care will notify the Department of changes in accordance with Department procedures.

3.6              Change in Family Size.  The Member must notify Pro Care as soon as possible of changes in the Member’s family such as a divorce, an adoption or change in child custody.  The Member must notify Pro Care either by telephoning or writing to the Member Services Department.  Pro Care will notify the Department of changes in accordance with Department procedures.

3.7              Final Determination.  In all cases, the Department will make the final determination of an individual’s eligibility for the Medicaid Program and the individual’s   enrollment and right to continue enrollment in Pro Care.

                                                                   ARTICLE 4 - MEMBER RIGHTS AND RESPONSIBILITIES

4.1              Certificate  Compliance. This Certificate describes and states the Member’s rights and responsibilities and Pro Care’s rights and responsibilities. It is the Member’s responsibility to read and understand this Certificate.  By enrolling in Pro Care, the Member agrees to comply with this Certificate.  The Member’s rights and responsibilities are described and stated throughout this Certificate and in the Member Handbook in addition to the general provisions described and stated in this Article 4.

4.2              Medical Questionnaires and Other Forms.  The Member must complete and submit medical questionnaires and other forms that are reasonably requested by Pro Care.  The Member must provide true, correct and complete information on these questionnaires and forms.  If the Member intentionally provides false or misleading information or omits a material fact on a questionnaire or form, the Member’s enrollment in Pro Care may be terminated under Article 9 of this Certificate.

4.3              Identification Card.  Pro Care will issue an Identification Card to the Member.  The Member must present the Identification Card to Participating Providers each time the Member obtains Covered Services.  The Identification Card is the property of Pro Care and Pro Care may request the Member to return an Identification Card at any time.

4.4              Misuse of Identification Card.  If the Member misuses the Identification Card, permits another person to use the Card, or otherwise defrauds (or tries to defraud) Pro Care, Pro Care may immediately request the Member to return the Identification Card to Pro Care.  The Member’s enrollment in Pro Care, and the enrollment of any other Members in the household, may be terminated under Article 9 if the Member misuses the Card, permits another person to use the Card, or otherwise defrauds or tries to defraud Pro Care,

4.5              Loss or Theft of Identification Card.  The Member must promptly notify Pro Care of the loss or theft of the Member’s Identification Card.  The Member must notify Pro Care either by telephoning or writing to the Member Services Department.

4.6              Member Handbook.  The Member will receive a copy of the Member Handbook when the Member enrolls in Pro Care.  Pro Care  will notify the Member of any changes to the Member Handbook.  The Member may request additional copies of the Member Handbook at any time by telephoning or writing to the Member Services Department.

4.7              Grievance and Appeal Procedures.  Pro Care has internal procedures for receiving, processing and resolving Member concerns relating to any aspect of health services or administrative services, including authorizations for medical services.  An external grievance and appeal procedure administered by the Office of Insurance and a Medicaid Fair Hearing Process are also available to Members.  The Member Handbook describes Pro Care’s internal grievance and appeal procedure, the Office of Insurance external grievance procedure, and the Medicaid Fair Hearing Process.  The Member may call Pro Care’s Member Services Department if the Member has a question concerning Pro Care’s internal grievance procedures or the external processes.  The telephone number of the Member Services Department is in the Member Handbook.

4.8              Fraud and Abuse.     Pro Care has a compliance program for identifying, addressing and reporting instances of fraud and abuse.  The Member should report to Pro Care any suspected fraud or abuse involving the Medicaid Program.  The Member Handbook has information about reporting suspected fraud and abuse to Pro Care or government agencies.  Abuse includes health care provider or Member practices that result in unnecessary costs to the Medicaid Program or in reimbursement for services that are not medically necessary.  Fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception or misrepresentation could result in some unauthorized benefit to the person or some other person, including any act constituting fraud under federal or state law.

4.9              Reasonable Accomodation.  Pro Care will make reasonable accommodation for Members with hearing and/or visual impairments.

4.10          Advance Directives.  Pro Care has policies and procedures for the use and handling of Members’ advance directives.  Pro Care’s Member Handbook describes the Members’ right to have and exercise advance directives under Michigan law.  An advance directive is a Member’s written instruction, such as a living will or durable power of attorney for health care as recognized under Michigan law, relating to the provision of health care if the Member is incapacitated.

4.11          Member Inclusion.    Pro Care has written guidelines and a process to reasonably ensure that Members are provided Covered Services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference, physical or mental handicap, residence in the Service Area, or lawful occupation.

4.12          Member Health and Other InformationPro Care must keep the Member’s protected health information confidential under Michigan and federal laws, including HIPAA.  Pro Care must not use or disclose the Member’s protected health information to other persons if the use or disclosure violates state or federal laws.  Pro Care will provide the Member a Notice of Privacy Practices that describes the Member’s rights and obligations and Pro Care’s rights and obligations regarding the Member’s protected health information.  The Department and the federal Centers for Medicare and Medicaid Services will have access to Members’ medical records without obtaining Members written approval before requesting the medical records.  Pro Care must comply with state and federal law regarding the Member’s right to access and review the Member’s medical record. Pro Care will protect from unauthorized disclosure all Member information collected, maintained or used in the administration of the Medicaid Contract.

4.13          Pro Care’s Board of Directors.  As required by law, at least one-third of the Directors on Pro Care’s Board of Directors must be adult Members elected by subscribers.  Pro Care will notify all subscribers of the date of subscriber elections and each subscriber will have the right to vote for Member nominees for the Board of Directors.  Nominations and elections of Directors will be reported in Pro Care’s periodic newsletter.  The Member may contact Pro Care’s Member Services Department for information on becoming a Director.

4.14          Protection Against Liability for Payment and Balance Billing.    The Member will not be liable for payment to Pro Care or health care providers for Covered Services provided to the Member, except as specifically stated in this Certificate. 

4.15          Pro Care’s Policies and Procedures.  The Member is responsible for becoming familiar with and following the policies and procedures which Pro Care adopts from time to time to administer the Medicaid Contract, the Certificate and Pro Care .  Pro Care  will provide copies of its policies and procedures to the Member upon request, and will provide information regarding policies and procedures in Pro Care ’s newsletter and other written communication to Members.

4.16          Member Request for Information.  The Member should refer to Pro Care’s Provider Directory for a listing of current Participating Providers, including names and locations of Participating Providers by specialty or type and which Participating Providers will not accept new Members.  This Certificate and the Member Handbook describe limitations of accessibility and referrals to specialists, prior authorization requirements and Non-Covered Services. In addition, as required by the Insurance Code, upon request of the Member, Pro Care will provide a description of any of the following information requested by the Member:

A.                Professional credentials of Participating Physicians and other health professionals who are Participating Providers;

B.                 The licensing verification telephone number for the Michigan Department of Community Health that can be accessed for information regarding disciplinary actions or open complaints against a health professional Participating Provider;

C.                 The financial relationship between Pro Care and any Participating Provider; or

D.                A telephone number and address to obtain additional information concerning the Provider Directory, limitations of accessibility and referrals to specialists, prior authorization requirements, Non-Covered Services or any of the items described above in paragraphs A through C.

ARTICLE 5 - RELATIONSHIPS WITH PARTICIPATING AND NON-PARTICIPATING PROVIDERS

5.1              Choosing a PCP.  At the time of enrollment in Pro Care, the Member should choose his/her PCP from Pro Care’s Provider Directory.  The Provider Directory lists all Participating Physicians who are primary care Physicians.  The Member may choose a clinic as a PCP if the clinic is listed in the Provider Directory as a PCP.  If a Member is a minor or otherwise incapable of selecting a PCP, an authorized person may select a PCP on behalf of the Member.  An authorized person may select a pediatrician who is a Participating Physician as the PCP for a Member who is a minor.  Pro Care will allow a Specialist to be the Member’s PCP if it is necessary for the Specialist to manage the Member’s medical condition.  This might be necessary for a medical condition such as diabetes, end-stage renal disease, HIV/AIDS or other chronic disease or disability.  If Pro Care cannot honor the Member’s choice of a PCP, Pro Care will notify the Member to allow the Member to choose an alternate PCP or to disenroll.  Disenrollment will be determined by the Department.  Pro Care will select a PCP for a Member if the Member (or an authorized person on behalf of the Member) does not select a PCP within ten days of the effective date of enrollment.  Pro Care will notify the Member of the PCP that Pro Care selected for the Member. Pro Care will inform the Member of the hours of operation and office locations of the PCP that the Member has chosen or that Pro Care has selected for the Member. 

5.2              Changing a PCP.  The Member may change to a different PCP by making a verbal or written request to Pro Care ’s Members Services Department.  A PCP change is effective on the first day of the following month if requested by the 25th day of the current month. The member should verify the effective date of change when the Member requests the change.

5.3              Role of PCP.  The Member’s PCP provides primary care services and arranges and coordinates the provision of other health care services for the Member, including referrals to specialists, ordering lab tests and x-rays, prescribing medicines, and arranging hospitalization.

5.4              Specialists and other Participating Providers.  Except as otherwise expressly stated in this Certificate, the Member must obtain a referral from the PCP or, when required, authorization from Pro Care, before the Member receives Covered Services from a Specialist or other Participating Provider.  If the Member does not obtain the necessary referral or authorization from the PCP or Pro Care, Pro Care will not pay for any of the medical services, equipment, and supplies that the Member receives from the Specialist or other Participating Provider.  It is not necessary to obtain a referral or authorization to receive the following services from Participating Providers: (i) Emergency Services; (ii) Family Planning Services; (iii) outpatient mental health services for up to 20 visits per Contract Year; (iv) covered vision services; or (v) an annual well-woman examination and routine obstetrical and routine gynecological services from an obstetrician-gynecologist.

5.5              Non-Participating Providers.  The Member may occasionally require Covered Services from Non-Participating Providers.  On these rare occasions, the Member must obtain authorization from Pro Care  before the Member receives any Covered Services from the Non-Participating Provider, except as otherwise specifically stated in this Certificate.  If the Member does not receive authorization from Pro Care, Pro Care will not pay or reimburse the Non-Participating Provider or the Member for any of the medical services, equipment and supplies received from the Non-Participating Provider, except under the following circumstances:  (i) the services are Medically Necessary Covered Services; and (ii) the services could not reasonably be obtained from a Participating Provider; and (iii) Pro Care did not respond to a the request for authorization within 24-hours after the request was made.  If Pro Care does not have a Participating Provider available for a second opinion within its provider network, the Member may obtain a second opinion from a Non-Participating Provider at no cost to the Member with Pro Care’s prior authorization. It is not necessary to obtain authorization from Pro Care before receiving the following services from Non-Participating Providers: (i) Emergency Services; (ii) treatment of Communicable Diseases at the Member’s local health department; (iii) Family Planning Services; and (iv) Covered Services from a CAHCP provider.  If there is not a Participating Provider Federally Qualified Health Center in the county where the Member resides, the Member may obtain routine health care services from a Non-Participating Federally Qualified Health Care Center without prior authorization from Pro Care.

5.6              Independent Contractors.  Pro Care contracts with Participating Providers who provide Covered Services to Members.  The Participating Providers are independent contractors.  They are not employees, agents, partners or co-venturers of Pro Care.  Participating Providers are solely responsible for exercising independent medical judgments.  A Participating Provider and the Member may initiate or continue medical services despite Pro Care ’s decision that the services are Non-Covered Services.  Pro Care will not pay or reimburse the Participating Provider or the Member for any of these Non-Covered Services.  The Member may appeal Pro Care ’s decision on whether services are Covered Services by following the grievance and appeal procedures described in the Member Handbook.

5.7              Availability of Participating Providers.  Pro Care does not represent or promise that a specific PCP or other Participating Provider will be available to render services throughout the period that the Member is enrolled in Pro Care.  Pro Care or the Participating Provider may terminate the provider contract or limit the number of Members that the Participating Provider will accept as patients.  If the Participating Provider contract of the Member’s PCP is terminated, the Member must select another PCP.  Pro Care will notify the Member of the termination of the PCP’s Participating Provider contract and will assist the Member in choosing a new PCP before termination of the contract. If a Specialist who is rendering services to a Member ceases to be a Participating Provider, the Member must cooperate with the Member’s PCP or Pro Care in referring the Member to another Specialist to render the Covered Services.

5.8              Inability to Establish or Maintain a Physician-Patient Relationship.  If the Member is unable to establish or maintain a satisfactory relationship with a PCP or a Specialist, Pro Care may request the Member to select another PCP, or may arrange to have the Member’s PCP refer the Member to another Specialist.  If the Member is unable to establish or maintain a satisfactory relationship with Participating Physicians, the Member’s enrollment in Pro Care may be terminated under Article 9.

5.9              Refusal to Accept or Follow Treatment.  For personal or religious reasons, a Member may refuse to accept or follow the treatment(s) or procedure(s) recommended as necessary by a Participating Physician.  The Participating Physician may request that the Member select another Participating Physician if a satisfactory relationship with the Member cannot be maintained because of the Member’s refusal to follow such treatment recommendations or orders.

                                                                              ARTICLE 6 - PAYMENT FOR COVERED SERVICES

6.1              Periodic Premium Payments.  The State of Michigan will pay the Premium directly to Pro Care, on behalf of the Member. The State of Michigan will pay the Premium on or before the due date specified in the Medicaid Contract.  The Member is entitled to Covered Services under this Certificate for the period to which the Premium applies.

6.2              Copayments.  A Member must pay or arrange for payment of Copayments at the time a Covered Service is provided.  Copayments, if any, are set forth in Appendix D of the Certificate.  A Participating or Non-Participating Provider may require the Member to pay the Copayment in cash at the time of delivery of the Covered Services.  A Participating or Non-Participating Provider may not deny Covered Services to the Member due to the Member’s inability to pay the Copayment.

6.3              Claims.

6.3.1        It is Pro Care ’s policy to pay Participating Providers directly for Covered Services provided to Members in accordance with the provider contracts between Pro Care  and Participating Providers.  However, if a Participating Provider bills the Member for a Covered Service, the Member should contact the Member Services Department upon receipt of the bill.  If the Member pays a bill for Covered Services, Pro Care will require the Participating Provider to reimburse the Member.

6.3.2        If the Member receives Emergency Services, Family Planning Services, treatment of Communicable Diseases or CAHCP Covered Services from a Non-Participating Provider, the Member should request the Non-Participating Provider to bill Pro Care.  If the Non-Participating Provider refuses to bill Pro Care but bills the Member, the Member should submit the bill to Pro Care.  If the Non-Participating Provider requires the Member to pay for the Emergency Services, Family Planning Services, Communicable Disease treatment services or CAHCP Covered Services at the time they are rendered, the Member must submit a request for reimbursement for such Covered Services in writing to Pro Care within 60 days after the date the Covered Services were provided to the Member.

6.3.3        If Pro Care authorizes the Member to receive Covered Services from a Non-Participating Provider, the Member should request the Non-Participating Provider to bill Pro Care.  If the Non-Participating Provider refuses to bill Pro Care but bills the Member, the Member should submit the bill to Pro Care.  If the Non-Participating Provider requires the Member to pay for the Covered Services at the time they are rendered, the Member must submit a request for reimbursement for such Covered Services in writing to Pro Care within 60 days after the date the Covered Services were provided to the Member.

6.3.4        If the Member requests reimbursement for Covered Services, the Member must submit acceptable proof that the Member paid the Non-Participating Provider for the Covered Services.  The Member should submit the proof of payment at the same time as the request for reimbursement.  If the Member is not reasonably able to submit proof of payment at the same time the Member makes a request for reimbursement, Pro Care  will reimburse the Member for the Covered Services if the Member provides proof of payment as soon as reasonably possible.  However, ProCare will not be obligated to reimburse the Member if the Member submits proof of payment more than 12 months after the date Covered Services were provided to the Member.

6.3.5        ProCare may require the Member to provide additional medical and other information or documentation to prove that services rendered were Covered Services before paying Non-Participating Providers or reimbursing the Member for such services, subject to applicable state and federal law.

6.4              Non-Participating Providers.  Pro Care will not pay a Non-Participating Provider or reimburse the Member for any services, supplies or equipment provided by a Non-Participating Provider that are not authorized in advance by Pro Care except under the following circumstances:  (i) the services are Medically Necessary Covered Services; and (ii) the services could not reasonably be obtained from a Participating Provider; and (iii) Pro Care did not respond to a the request for authorization within 24-hours after the request was made.  Pro Care will pay Non-Participating Providers for Emergency Services, Family Planning Services, treatment of Communicable Diseases at the Member’s local health department and Covered Services by a CAHCP provider as set forth in this Certificate.

6.5              Non-Covered Services.  Pro Care will not pay a Participating Provider or a Non-Participating Provider, or reimburse the Member, for any Non-Covered Services received by the Member if the Member knew or reasonably should have known that the services were Non-Covered Services at the time the services were rendered.  Pro Care may recover from the Member the expenses for Non-Covered Services.

                                                                                                             ARTICLE 7 - COVERED SERVICES

7.1              Covered Services.  The Member is entitled to the Covered Services specified in Appendix A when all of the following conditions are met:

7.1.1        The Covered Services are specified as services covered by the Medicaid Program in the Medicaid Contract at the time that services are rendered, as those services are changed, limited and deleted from time to time by the Medicaid Program.  All changes, limitations and deletions from Medicaid coverages will automatically apply to the Member.  The details of all current Medicaid coverages are contained in Medicaid Program policy manuals and publications.  Members are only entitled to Covered Services consistent with the current Medicaid coverages.

7.1.2        The Covered Services are Medically Necessary.  Except as otherwise required by law, a Participating Provider’s determination that a Covered Service is medically necessary is not binding on Pro Care.

7.1.3        The Covered Services are performed, prescribed, directed or arranged in advance by the Member’s PCP, except when a Member may directly access the services of a Specialist or other Participating Provider or a Non-Participating Provider under the express terms of this Certificate.

7.1.4        The Covered Services are authorized in advance by Pro Care, when required.

7.1.5        The Covered Services are provided by Participating Providers, except for services authorized in advance by Pro Care or as otherwise expressly set forth in this Certificate.

7.2              Emergency Services.  In case of an Emergency Medical Condition, the Member should go directly to a Hospital emergency room.  The Member, the Hospital or a responsible person must notify Pro Care as soon as possible after the Member receives Emergency Services.  All follow-up and continuing care that are not Emergency Services must be authorized in advance by Pro Care or the Member’s PCP.  Pro Care  will not deny payment for Emergency Services up to the point of stabilization because of the final diagnosis or lack of prior authorization.

7.3              Urgent Care.  Urgent Care must be authorized in advance by the Member’s PCP.  All follow-up and continuing care must be authorized in advance by the Member’s PCP.

7.4              Out-of-Network Services.  Except as otherwise expressly stated in this Certificate, Covered Services by Non-Participating Providers must be authorized in advance by Pro Care. 

7.5              Out-of-Area Services.

7.5.1        Covered ServicesEmergency Services are covered by Pro Care while the Member is temporarily out of the Service Area.  The Member, the Hospital or a responsible person must notify Pro Care as soon as possible after the Member receives Emergency Services.  Urgent Care and other Covered Services must be authorized in advance by Pro Care.  If the Covered Services are Medically Necessary and could not be reasonably obtained from a Participating Provider, the Covered Services are considered authorized by Pro Care if Pro Care does not respond to a request for authorization within 24 hours of the request.

7.5.2        Hospitalization.  If an Emergency Medical Condition requires hospitalization, the Member, the Hospital or a responsible person must notify Pro Care  as soon as possible after the emergency hospitalization begins.  Pro Care  may require the Member to move to a Participating Hospital when it is physically possible to do so.

7.6              Coordination of Care Services.  Pro Care will refer Members to agencies or others for certain services, such as certain behavioral health and developmental disability service,  which the Member may be eligible to receive, but which are not Covered Services under this Certificate.  These services are set forth on Appendix B.  The State of Michigan or other agency or entity will be responsible for paying for these services.

                                                                                      ARTICLE 8 - EXCLUSIONS AND LIMITATIONS

8.1              Exclusions.  The services, equipment and supplies listed on Appendix C are Non-Covered Services.  In addition, any health care services provided before the effective date of coverage or after the coverage under this Certificate has terminated are Non-Covered Services, except as otherwise expressly stated in this Certificate.

8.2              Limitations.

8.2.1        Pro Care  has no liability or obligation for payment for any services, equipment or supplies provided by Non-Participating Providers unless the services, equipment or supplies are Covered Services and are authorized in advance by Pro Care, except when this Certificate otherwise specifies that the Member may obtain Covered Services from Non-Participating Providers without prior authorization.

8.2.2        A referral by a PCP for Non-Covered Services does not make such services Covered Services.

8.2.3        ProCare  will not cover services, equipment or supplies not performed, provided, prescribed, directed or arranged by the Member’s PCP or, where required, not authorized in advance by Pro Care, except when this Certificate otherwise specifies that Pro Care  will cover such services.

8.2.4        ProCare will not cover services, equipment or supplies that are not Medically Necessary.

                                                                                                  ARTICLE 9 - TERM AND TERMINATION

9.1              Term.  This Certificate takes effect on the effective date of coverage as specified in Article 3.  This Certificate continues in effect from year to year thereafter unless otherwise specified in the Medicaid Contract or unless terminated in accordance with this Certificate.

9.2              Termination of Certificate by Pro Care or the Department.

9.2.1        This Certificate will automatically terminate upon the effective date of termination of the Medicaid Contract.  Enrollment and coverage of all Members will terminate at 12:00 Midnight on the date of the termination of this Certificate, except as otherwise provided by the Medicaid Contract.

9.2.2        If Pro Care stops operating or dissolves, this Certificate may be terminated immediately by court or administrative agency order or by the Board of Directors of Pro Care.  Pro Care  will be responsible for Covered Services for the Member to the extent that Premiums were paid on behalf of the Member or as otherwise prescribed by law or by the Medicaid Contract.

9.2.3        The Department will be responsible for notifying Members of the termination of this Certificate.  ProCare will not notify Members of the termination of this Certificate.  The fact that Members are not notified of the termination of this Certificate will not continue or extend Members’ coverage beyond the date of termination of this Certificate.

9.2.4        The enrollment and coverage of all Members terminates on the effective date of termination of this Certificate under this Section 9.2.

9.3              Department Disenrollment of the Member. 

9.3.1        The Department may disenroll the Member when any of the following occurs:

A.                the Department erroneously enrolled the individual in Pro Care; or

B.                 the Member ceases to be eligible for the Medicaid Program as determined by the Department; or

C.                 the Member dies; or

D.                the Member moves out of the Service Area.

9.3.2        In all cases, the Department will make the final decision concerning disenrollment of the Member under this Section 9.3.  The effective date of disenrollment will be determined by the Department.

9.3.3        The Member’s coverage under this Certificate terminates automatically on the effective date of the Member’s disenrollment, except as provided in Section 9.6.

9.4              Pro Care Request for Disenrollment of the Member. 

9.4.1        Pro Care may request the Department to disenroll the Member for any of the following reasons:

A.                the Member becomes medically eligible for the Children’s Special Health Care Services program and the family chooses to enroll in the CSHCS program; or

B.                 the Member is admitted to a nursing facility for custodial care or remains in a nursing facility for rehabilitative care for longer than 45 days; or long-term care facility unless the Member is a hospice patient; or

C.                 the Member is admitted to a State of Michigan psychiatric hospital or an intermediate care facility for the mentally retarded as defined by the Medicaid Contract; or.

D.                the Member is incarcerated in a correctional facility; or

E.                 the Member is served under the Home & Community Based Elderly Waiver; or

F.                  the Member is unable to establish or maintain, after reasonable attempts by two Participating Physicians, a satisfactory physician-patient relationship; or

G.                the Member makes material lies, omits facts, or otherwise commits fraud in completing medical questionnaires or other forms requested by ProCare  or the Department; or

H.                the Member’s circumstances change such that the Member no longer meets the criteria for enrollment in ProCare as defined by the Department;

I.                   the theft or alteration of prescriptions, the misuse or fraud in the use of the Member’s Identification Card, or other fraud or misrepresentation in the Member’s use of ProCare ’s benefits and services; or

J.                   the Member’s physical or verbal conduct is violent, threatening, abusive or obstructive to ProCare’s personnel, Participating Providers or other Members; or

K.                the Member is non-compliant with or misuses Pro Care ’s benefits and services, including failure to follow treatment plan, unauthorized repeated use of Non-Participating Providers, repeated use of Hospital emergency rooms for conditions that are not Emergency Medical Conditions, and other non-compliant situations that impede care; or

L.                 the Member fails to cooperate in coordinating benefits or subrogating the Member’s rights of recovery.

9.4.2        ProCare will not request the Department to terminate the Member’s enrollment and coverage on the basis of the Member’s physical or mental status or the fact that the Member has exercised the Member’s rights under Pro Care’s Grievance Procedure.

9.4.3        In all cases, the Department will make the final decision concerning disenrollment of the Member under this this Section 9.4.  The effective date of disenrollment will be determined by the Department.

9.4.4        The Member’s coverage under this Certificate terminates automatically on the effective date of the Member’s disenrollment, except as provided in Section 9.6.

9.5              Member Request for Disenrollment.

9.5.1        The Member will remain enrolled in ProCare for 12 months after the effective date of enrollment, except as follows:

A.                If the Member has changed enrollment from another Medicaid health plan to ProCare, the Member may request the Department to disenroll the Member without cause from Pro Care at any time during the first 90 days after the effective date of enrollment in Pro Care; or

B.                 The Member may disenroll from Pro Care during an annual open enrollment period as determined by the Department.  The Department will notify the Member of the annual open enrollment period; or

C.                 At any time, the Member may request the Department to disenroll the Member from Pro Care because of poor quality of care, lack of access to providers or necessary specialty Covered Services, or other good reason as determined by the Department.

9.5.2        After enrollment in Pro Care for 12 months, the Member may request the Department to disenroll the Member from Pro Care  as follows:

A.                The Member may disenroll from Pro Care during an annual open enrollment period as determined by the Department.  The Department will notify the Member of the annual open enrollment periods; or

B.                 At any time, the Member may request the Department to disenroll the Member from Pro Care  because of poor quality of care, lack of access to providers or necessary specialty Covered Services, or other good reason as determined by the Department.

9.5.3        The Member’s coverage under this Certificate terminates automatically on the effective date of the Member’s disenrollment.  The effective date of disenrollment will be determined by the Department.

9.6              Continuation of Benefits.  If the Member is an inpatient at a Hospital on the date that the Member’s enrollment in Pro Care terminates, Pro Care  is responsible for payment for the inpatient Hospital stay until the date of discharge, subject to exceptions for disenrollments based on Children’s Special Health Care Services enrollments.

                                                                                        ARTICLE 10 - COORDINATION OF BENEFITS

10.1          Purpose.  In order to avoid duplication of benefits to Members by Pro Care and other Payers, Pro Care will coordinate benefits for the Member under this Certificate with benefits available from other Payers that also provide coverage for the Member.

10.2          Notification.  The Department will furnish Pro Care with notice of all other Payers providing health care benefits to the Member.  The Member must notify Pro Care  of any health insurance or health plan benefits, rights to payment and money paid for any claims for health care when the Member learns of them.  The Member must also notify Pro Care when payment of health care benefits from any other Payer becomes available to the Member.

10.3          Order of Benefits.  In establishing the order of Payer responsibility for health care benefits, Pro Care will follow coordination of benefits guidelines authorized by the Department and Office of Insurance and applicable provisions of the Michigan Coordination of Benefits Act, Public Act 64 of 1984, as amended, MCL 550.251 et seq.  For Members with Medicare coverage, Medicare will be the primary payer ahead of Pro Care.

10.4          ProCare’ s Rights.  ProCare  will be entitled to:

A.                determine whether and to what extent the Member has health insurance or other health benefit coverage for Covered Services; and

B.                 establish, in accordance with this Article, priorities for determining primary responsibility among the Payers obligated to provide health care services or health insurance; and

C.                 require the Member, a Participating Provider or a Non-Participating Provider to file a claim with the primary Payer before it determines the amount of ProCare ’s payment obligation, if any; and

D.                recover from the Member, Participating Provider or Non-Participating Provider, as applicable, the expense of Covered Services rendered to the Member to the extent that such Covered Services are covered or indemnified by any other Payer.

10.5          Construction.  Nothing in this Article shall be construed to require ProCare to make a payment until it determines whether it is the primary Payer or the secondary Payer and the benefits that are payable by the primary Payer, if any.

10.6          Definition.  As used in this Article 10, “Payer” means all insurance and other benefit plans, policies, and programs that may be liable for payment or reimbursement for health care services rendered to the Member, including Medicare, employer-sponsored health plans, self-funded and self-insured plans, commercial health insurance carriers, automobile insurance and workers compensation and other private and governmental plans, policies and programs.

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