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Member Handbook

Important Notice: As of October 1, 2017, District of Columbia Healthy Families and Healthcare Alliance members will receive benefits through Amerigroup District of Columbia (Amerigroup DC). Learn more >

Below is the MedStar Family Choice handbook that all members receive when they enroll into MedStar Family Choice. This handbook provides detailed benefit information, as well as information on MedStar Family Choice policies and procedures.

Click here to view the entire DC Healthcare Alliance Member Handbook

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Table of Contents

Important Phone Numbers

Welcome to MedStar Family Choice

How this Handbook Works

  • How this member handbook can help you

Your Rights and Responsibilities

Your Member Identification (ID) Card

Your Primary Care Provider (PCP)

  • How to pick your PCP
  • How to change your PCP

Your Main Dental Office

Routine Care, Urgent Care and Emergency Care

  • Routine Care
  • Urgent Care
  • Emergency Care
  • What to do if you have an emergency

Care When You Are Out-of-Town

MedStar Family Choice Providers and Nonproviders

Making an Appointment with Your PCP

  • Changing or canceling an appointment
  • Getting care when your PCP's office is closed
  • How long it takes to see your doctor

Support Services

  • Interpretation services
  • Translations services
  • Services for the hearing and visually impaired
  • Health education programs

Specialty Care and Referrals

  • How to get specialty care
  • Self-referral services
  • Birth control and other family planning services

Pharmacy Services and Prescription Drugs

Disease Management

Services to Keep Adults from Getting Sick

  • Recommendations for check ups
  • Adult screening recommendations
  • Screenings for women only
  • Screenings for men only
  • Preventative counseling
  • Adult Immunizations

Pregnancy

  • Prenatal and postpartum care

Your Health Benefits

  • Health services covered by MedStar Family Choice
  • Services we do not pay for
  • Notice of changing benefits or service locations

Other Important Information

  • What to do if you move
  • What to do if you have a baby
  • What to do if someone in your family dies
  • How to change your managed care organization (MCO)
  • What to do if you get a bill for a covered service
  • Paying for services that are not covered
  • Advance directives
  • What to do if you have other insurance
  • Physician (doctor) incentive plan disclosure
  • How to make suggestions for changes in policies and procedures
  • Out-of-pocket expenses
  • New technology
  • Website

Complaints, Grievances, Appeals and Fair Hearings

  • Complaints/grievances
  • Appeals and fair hearings
  • Deadlines
  • Appeals
  • Expedited (emergency) complaints/grievances and appeals process
  • Your rights during the complaints/grievances, appeals and fair hearings process

Notice of Privacy Practices

Fraud and Abuse

What Some Words Mean

Information current as of: 10/16/17