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 download entire DC Healthy Families 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 Card

Your Primary Care Provider (PCP)

  • How to pick your PCP
  • Types of primary doctors to choose from
  • Things to know when choosing a primary doctor
  • 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

  • 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
  • Translation services
  • Services for the hearing and visually impaired
  • Transportation services
  • Health education programs

Specialty Care and Referrals

  • How to get specialty care
  • Self-referral services
  • Behavioral health services
  • Services for alcohol or other drug problems
  • 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 and adolescent immunizations
  • Prenatal and postpartum care

Your Child's Health

  • Health Check program for children (EPSDT)
  • Immigrant children
  • Caring for your children's teeth
  • Children with special healthcare needs
  • Strong Start Early Intervention program
  • Immunizations (shots) for children and teens

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 you adopt a child
  • What to do if someone in your family dies
  • How to change your 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
  • What to do if you are eligible for both Medicaid and Medicare
  • 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 and Grievances
  • Appeals and fair hearings
  • Expedited (emergency) grievances and appeals process
  • Your rights during the grievances, appeals, and fair hearings process

Notice of Privacy Practices

Fraud and Abuse

Medicare Part D Notice

What Some Words Mean

Information current as of: 08/30/19