Member Handbook

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.

To view the entire handbook MedStar Family Choice Enrollee Handbook Revised (January 2018)

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I. HealthChoice Overview

II. Important Information

III. Rights and Responsibilities

IV. Benefits and Services

  • HealthChoice Benefits
  • Self-Referral Services
  • Benefits Not Offered by MCOs But Offered By the State
  • Additional Services Offered by MCOs and Not by the State
  • Excluded Benefits and Services Not Covered by MOCs of the State
  • Change of Benefits or Service Locations

V. Information on Providers

  • What is a PCP, a Specialist, and Specialty Care
  • Selecting or Changing Providers
  • Termination of a Provider

VI. Getting Into Care

  • Making or Canceling an Appointment
  • Referral to a Specialist or Specialty Care
  • After Hours, Urgent Care, and Emergency Care services
  • Out-of-Service Area Coverage
  • Wellness Care for Children (Healthy Kids-EPSDT)
  • Wellness Care for Adults
  • Case Management
  • Care for Women During Pregnancy or Two Months After Delivery
  • Family Planning (Birth Control)
  • Adult Dental Care
  • Dental Care
  • Vision Care
  • Health Education/Outreach
  • Behavioral Health Services

VII. Special Services

  • Services for Specialty Needs Populations
  • Rare and Expensive Case Management Program (REM)

VII. Utilization Management

IX. Billing

X. Complaints, Grievances, and Appeals

XI. Changing Your MCO

XII. Reporting Fraud and Abuse

ATTACHMENT A - MCO Contact Information

ATTACHMENT B - Notice of Privacy Practices

ATTACHMENT C - Additional Services Offered by MCO

ATTACHMENT D - Prenatal/Postpartum Programs

ATTACHMENT E - Health Education Programs

ATTACHMENT F - MCO Internal Complaint/Appeal Process

ATTACHMENT G - Other Important Information

ATTACHMENT H - Advanced Directives

ATTACHMENT I - MedStar Family Choice Nondiscrimination Statement

Information current as of: 04/30/18