New to IEHP DualChoice

Look at your IEHP DualChoice Member Card to locate important phone numbers including your Doctor, IEHP DualChoice Member Services, and IEHP’s 24-Hour Nurse Advice Line.

When you first join our plan, you get a health risk assessment (HRA) within 90 days before or after your effective enrollment date. 

We must complete an HRA for you. This HRA is the basis for developing your care plan. The HRA include questions to identify your medical, Long Term Services and Support (LTSS), and behavioral health and functional needs. 

We reach out to you to complete the HRA. We can complete the HRA by an in-person visit, telephone call, member portal or mail. We’ll send you more information about this HRA upon your enrollment with the plan. 

If our plan is new for you, you can keep using the doctors you use now for a certain amount of time, if they are not in our network. We call this continuity of care. If they are not in our network, you can keep your current providers and service authorizations at the time you enroll for up to 12 months if all of the following conditions are met: 

• You, your representative, or your provider asks us to let you keep using your current provider. 
• We establish that you had an existing relationship with a primary or specialty care provider, with some exceptions. When we say “existing relationship,” it means that you saw an out-of-network provider at least once for a non-emergency visit during the 12 months before the date of your initial enrollment in our plan.
  • We determine an existing relationship by reviewing your available health information available or information you give us.
  • We have 30 days to respond to your request. You can ask us to make a faster decision, and we must respond in 15 days.
  • You or your provider must show documentation of an existing relationship and agree to certain terms when you make the request.

Note: You can only make this request for services of Durable Medical Equipment (DME), transportation, or other ancillary services not included in our plan. You cannot make this request for providers of DME, transportation or other ancillary providers.

After the continuity of care period ends, you will need to use doctors and other providers in the IEHP DualChoice network that are affiliated with your primary care provider’s medical group, unless we make an agreement with your out-of-network doctor. A network provider is a provider who works with the health plan. Our plan’s PCPs are affiliated with medical groups or Independent Physicians Associations (IPA). When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are affiliated with their medical group. A medical group or IPA is a group of physicians, specialists, and other providers of health services that see IEHP Members. Your PCP, along with the medical group or IPA, provides your medical care. This includes getting authorization to see specialists or medical services such as lab tests, x-rays, and/or hospital admittance. In some cases, IEHP is your medical group or IPA. Refer to Chapter 3 of your Member Handbook for more information on getting care.

Get the My Life. My Choice. app today. It stores all your advance care planning documents in one place online. Advance care planning (ACP) involves shared decision making to write down-in an advance care directive-a person’s wishes about their future medical care. ACP and the advance health care directive can bridge the gap between the care someone wants and the care they receive if they lose the capacity to make their own decisions. With this app, you or a designated person with Power of Attorney can access your advance health care directives at any time from a home computer or smartphone. You can also complete an Appointment of Representative Form. The form gives the other person permission to act for you. By clicking on this link, you will be leaving the IEHP DualChoice website.

Sign up for the free app through our secure Member portal.

Medicare approved IEHP DualChoice (D-SNP HMO) to provide these benefits as part of the Value-Based Insurance Design program. This program lets Medicare try new ways to improve Medicare Advantage plans.

IEHP DualChoice (HMO D-SNP) is an HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list.

Information on this page is current as of October 11, 2024.
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