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RealSolutionsB-TXMHB-0004-11 05.11B-FLMHB-0002-117.11Member HandbookAmerigroup Florida, Inc.Florida Medicaid/MediKids Program1-800-600-4441nwww.myamerigroup.com

www.myamerigroup.comDear Member:Welcome to Amerigroup Community Care. We are happy you chose us to arrange for quality health carebenefits for your family.This member handbook tells you how Amerigroup works and how to keep your family healthy. It alsoexplains how to get health care when you need it.You will get your Amerigroup ID card and more information from us in a few days. Your ID card tells youwhen your Amerigroup membership starts. The name of your family doctor is on the card, too. Pleasecheck your ID card right away. If the name of your doctor or any other information is not right, pleasecall us at 1-800-600-4441. We will send you a new ID card with the correct information.You can call 1-800-600-4441 and talk to a Member Services representative about your benefits or visitour web site at www.myamerigroup.com. You can also talk to a nurse on our 24-hour Nurse HelpLine ifyou need advice. We are here to help you get quality health care coverage.Thank you again for choosing us as your family’s health plan.Sincerely,William L. McHughChief Executive OfficerAmerigroup Community CareAmerigroup is a company of all kinds of people. We welcome all into our health plans. We do not basemembership on health status. If you have questions or concerns, please call 1-800-600-4441 and askfor extension 34925. Or visit www.myamerigroup.com.B-FLMHB-0002-11

AMERITIPS: HEALTH TIPS THAT MAKE HEALTH HAPPENYOU NEED TO GO TO YOUR DOCTOR NOW!WHEN IS IT TIME FOR A WELLNESS VISIT?All Amerigroup members need to have regular wellness visits. This way, your Primary Care Physician(PCP) can see if you have a problem before it gets worse. When you become an Amerigroup member,call your doctor and make the first appointment for you and your child before the end of 90 days.WELLNESS CARE FOR CHILDREN, THE CHILD HEALTH CHECK-UP PROGRAMChildren need more wellness visits than adults. These wellness visits for children are part of Florida’sChild Health Check-Up Program. Your child should get wellness visits at the times listed below:Newborn9 months old1 month old12 months old2 months old15 months old4 months old18 months old6 months old24 months oldAfter age 2, you and your child should keep going to your PCP every year for wellness visits.WHAT IF I BECOME PREGNANT?If you think you are pregnant, call your PCP or OB/GYN right away. This can help you have a healthy baby.If you have any questions or need help making an appointment with your PCP or OB/GYN, please callAmerigroup Community Care Member Services at 1-800-600-4441.ALERT! Keep the Right Care. Do Not Lose Your Health care Benefits — RecertifyYour Eligibility for Medicaid Benefits on Time. See Page 38 for More Details.B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 2

AMERIGROUP MEMBER HANDBOOKAMERIGROUP COMMUNITY CARE4200 W. Cypress Street, Suite 900Tampa, Florida E TO AMERIGROUP COMMUNITY CARE!You will get most of your health care services through Amerigroup Community Care. This memberhandbook will tell you how to use Amerigroup to get the health care you need.Table of ContentsAMERITIPS: HEALTH TIPS THAT MAKE HEALTH HAPPEN . 2WHEN IS IT TIME FOR A WELLNESS VISIT? . 2WELLNESS CARE FOR CHILDREN, THE CHILD HEALTH CHECK-UP PROGRAM . 2WHAT IF I BECOME PREGNANT? . 2WELCOME TO AMERIGROUP COMMUNITY CARE! . 6INFORMATION ABOUT YOUR NEW HEALTH PLAN . 6HOW TO GET HELP. 6Amerigroup Member Services Department . 6Amerigroup 24-Hour Nurse HelpLine. 7Other Important Phone Numbers . 7Your Amerigroup Member Handbook . 7YOUR IDENTIFICATION CARDS (ID CARDS) . 8YOUR DOCTORS . 8PICKING A PRIMARY CARE PHYSICIAN . 8SECOND MEDICAL OPINION . 9IF YOU HAD A DIFFERENT DOCTOR BEFORE YOU JOINED AMERIGROUP . 9IF YOUR PCP’S OFFICE MOVES, CLOSES OR LEAVES THE AMERIGROUP NETWORK. 9HOW TO CHANGE YOUR PCP . 9IF YOUR PCP ASKS FOR YOU TO BE CHANGED TO ANOTHER PCP . 9IF YOU WANT TO GO TO A DOCTOR WHO IS NOT YOUR PCP . 10PICKING AN OB/GYN . 10SPECIALISTS. 10GOING TO THE DOCTOR . 11YOUR FIRST DOCTOR’S APPOINTMENT . 11HOW TO MAKE AN APPOINTMENT . 11WAIT TIMES FOR APPOINTMENTS. 11WHAT TO BRING WHEN YOU GO FOR YOUR APPOINTMENT . 11HOW TO CANCEL AN APPOINTMENT . 11HOW TO GET TO A DOCTOR’S APPOINTMENT OR TO THE HOSPITAL. 12DISABILITY ACCESS TO AMERIGROUP NETWORK DOCTORS AND HOSPITALS . 12WHAT DOES MEDICALLY NECESSARY MEAN? . 12AMERIGROUP COVERED SERVICES . 12B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 3

INPATIENT HOSPITAL STAY (INCLUDING BEHAVIORAL HEALTH CARE) . 13OUTPATIENT SERVICES . 13EMERGENCY MEDICAL SERVICES AND CARE . 13DOCTOR SERVICES . 13FAMILY PLANNING SERVICES . 14MATERNITY CARE . 14PRESCRIPTION BENEFIT . 14BEHAVIORAL HEALTH CARE SERVICES . 14VISION SERVICES . 15HEARING SERVICES . 15DENTAL SERVICES . 16LAB AND X-RAY SERVICES . 16HOME HEALTH CARE . 16TRANSPLANT SERVICES. 16EXTRA AMERIGROUP BENEFITS. 16SERVICES COVERED BY FEE-FOR-SERVICE MEDICAID . 17DIFFERENT TYPES OF HEALTH CARE. 18ROUTINE, URGENT AND EMERGENCY CARE: WHAT IS THE DIFFERENCE? . 18Routine Care . 18Urgent Care . 18Emergency Care . 18WHAT IS AN EMERGENCY MEDICAL CONDITION? . 18WHAT IS AN EMERGENCY BEHAVIORAL HEALTH CONDITION?. 19WHAT IS POST-STABILIZATION? . 19HOW TO GET HEALTH CARE WHEN YOUR DOCTOR’S OFFICE IS CLOSED. 19HOW TO GET HEALTH CARE WHEN YOU ARE OUT OF TOWN. 19HOW TO GET CARE WHEN YOU CANNOT LEAVE YOUR HOME . 20WELLNESS CARE FOR CHILDREN AND ADULTS . 20WELLNESS CARE FOR CHILDREN, THE CHILD HEALTH CHECK-UP PROGRAM . 20Why Well-Child Visits Are Important For Children. 20When Your Child Should Get Well-Child Visits . 21Blood Lead Testing . 21Vision Screening . 21Hearing Screening . 21Dental Screening . 21Immunizations (Shots). 21WELLNESS CARE FOR ADULTS . 23WHEN YOU MISS ONE OF YOUR WELLNESS VISITS . 23SPECIAL CARE FOR PREGNANT MEMBERS . 24WHEN YOU BECOME PREGNANT . 24When You Have A New Baby . 25DISEASE MANAGEMENT . 25SPECIAL AMERIGROUP SERVICES FOR HEALTHY LIVING . 26HEALTH INFORMATION . 26HEALTH EDUCATION CLASSES . 27COMMUNITY EVENTS . 27B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 4

DOMESTIC VIOLENCE . 27MINORS . 28STATEMENT OF ADVANCE DIRECTIVE OR LIVING WILLS . 28A LIVING WILL . 28A DURABLE POWER OF ATTORNEY FOR HEALTH CARE . 29IS A LIVING WILL BETTER THAN A DURABLE POWER OF ATTORNEY FOR HEALTH CARE? . 29GRIEVANCES AND APPEALS. 29GRIEVANCES . 29First Level Grievance . 29Second Level Grievance. 30External Grievance Review . 30MEDICAL APPEALS . 31First Level Appeal . 31Second Level Appeal . 31External Appeals Review . 32EXPEDITED APPEALS . 32MEDICAID FAIR HEARING . 33CONTINUATION OF BENEFITS . 33PAYMENT APPEALS . 33OTHER INFORMATION . 34IF YOU MOVE . 34RECERTIFY YOUR MEDICAID BENEFITS ON TIME . 34ENROLLMENT LOCK-IN . 35DISENROLLING FROM AMERIGROUP . 35REASONS WHY YOU CAN BE DISENROLLED FROM AMERIGROUP . 36IF YOU GET A BILL . 36CHANGES IN YOUR AMERIGROUP COVERAGE . 36HOW TO TELL AMERIGROUP ABOUT CHANGES YOU THINK WE SHOULD MAKE . 37HOW AMERIGROUP PAYS PROVIDERS . 37SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES37RIGHTS . 38RESPONSIBILITIES . 39HOW TO REPORT SOMEONE WHO IS MISUSING THE MEDICAID PROGRAM . 39NOTICE OF PRIVACY PRACTICES . 43B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 5

WELCOME TO AMERIGROUP COMMUNITY CARE!Information about Your New Health PlanWelcome to Amerigroup Florida, Inc., doing business as Amerigroup Community Care. Amerigroup is aHealth Maintenance Organization (HMO) committed to helping you get the right care close to home.As a member of Amerigroup, you and your Primary Care Physician (PCP) will work together to help keepyou healthy and care for your health problems. Amerigroup helps you get quality health care. Thismember handbook is for all Amerigroup members who are eligible for Medicaid and MediKids. It willhelp you understand your health plan.How to Get HelpAmerigroup Member Services DepartmentIf you have any questions about your Amerigroup health plan, you can call our Member Servicesdepartment at 1-800-600-4441. You can call us Monday through Friday 8:00 a.m. to 7:00 p.m., Easterntime, except for holidays. If you call after 7:00 p.m., you can leave a voice mail message. A MemberServices representative will call you back the next working day. Member Services can help you with:This member handbookMember ID cardsHealth care benefitsChoosing or changing your doctorWhat services are offered at Amerigroup network hospitalsGoing to the emergency roomDoctor’s appointmentsFinding an Amerigroup network pharmacyGrievances and appealsHealth educationPlease also call Member Services:If you wish to request a copy of the Amerigroup Notice of Privacy Practices. This notice describeshow medical information about you may be used and disclosed and how you can get access to thisinformation.When you move. We will need to know your new address and phone number. You should also callthe Medicaid Options Hotline at 1-888-367-6554 to let them know your new address.For members who do not speak English, we can help in many different languages and dialects. Thisservice is also available for visits with your doctor at no cost to you. Please let us know if you need aninterpreter at least 24 hours before your appointment. Call Member Services for more information.B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 6

For members who are hearing impaired, call the toll-free AT&T Relay Service at 1-800-855-2880.Amerigroup will set up and pay for you to have a person who knows sign language help you during yourdoctor visits. Please let us know if you need an interpreter at least 24 hours before your appointment.Amerigroup 24-Hour Nurse HelpLineYou can call our 24-hour Nurse HelpLine at 1-800-600-4441 if you need advice on:How soon you need to get care for an illnessWhat kind of health care is neededWhat to do to take care of yourself before you see the doctorHow you can get the care that is neededWe want you to be happy with all the services you get from the Amerigroup network of doctors andhospitals. Please call Member Services if you have any problems. We want to help you correct anyproblems you may have with your care.Other Important Phone NumbersIf you have an emergency, call 911 or go to the nearest hospital emergency room right awayIf you want information about enrollment or disenrollment, you can call the Medicaid OptionsHotline at 1-888-367-6554The Department of Children and Families (DCF) Automated ACCESS Information and Customer CallCenter number is 1-866-762-2237The Subscriber Assistance Program number is 1-850-412-4502, and the statewide Consumer CallCenter number is 1-888-419-3456 (toll free)If you would like to contact your Area Medicaid Office: For Citrus, Hernando, Lake, Marion and Sumter counties, call 1-877-724-2358 For Pasco and Pinellas counties, call 1-800-299-4844 For Hardee, Highlands, Hillsborough, Manatee and Polk counties, call 1-800-226-2316 For Orange, Osceola, Seminole, and Brevard counties, call 1-877-254-1055 For Charlotte, Collier, DeSoto, Glades, Hendry, and Sarasota counties, call 1-800-226-6735 For Indian River, Martin, Okeechobee and St. Lucie counties, call 1-800-226-5082 For Broward County, call 1-866-875-9131 For Dade and Monroe counties, call 1-800-953-0555 For Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties, call 1-800-273-5880If you need a ride to a covered medical or dental appointment, please see the section How To GetTo A Doctor’s Appointment Or To The Hospital for the phone number for your countyIf you need behavioral health care, please call Member Services at 1-800-600-4441If you need eye care, call CompBenefits toll free at 1-800-491-9222If you need hearing care, call HEARx toll free at 1-800-698-6767If you would like information about our Disease Management programs, please call 1-800-600-4441and ask to speak with a Disease Management care managerYour Amerigroup Member HandbookThis handbook will help you understand your health plan. If you have questions, or need helpunderstanding or reading your member handbook, call Member Services. Amerigroup also has themember handbook in a large print version, an audio taped version and a Braille version. The other sideof this handbook is in Spanish.B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 7

Your Identification Cards (ID Cards)Each Medicaid-eligible member has a plastic Gold card as ID from the Department of Children andFamilies (DCF) office. To learn more about the Gold card, please get in touch with your area’s DCF office.You will also get an Amerigroup ID card. If you do not have your ID card yet, you will get it soon. Pleasecarry your Amerigroup ID card and your Gold card with you at all times. The card tells doctors andhospitals that you are a member of our health plan and who your PCP is. It also tells them that we willpay for the medically needed benefits listed in the section Amerigroup Covered Services.Your Amerigroup ID card has your PCP’s name and phone number on it. The date you became a memberis also shown. Your ID card lists many of the important phone numbers you need to know, like ourMember Services department and Nurse HelpLine. It also has the phone numbers for you to call to getdental, vision, hearing and behavioral health care. If your Amerigroup ID card is lost or stolen, call usright away at 1-800-600-4441. We will send you a new one.YOUR DOCTORSPicking a Primary Care PhysicianAll Amerigroup members must have a family doctor, also called a Primary Care Physician (PCP). Your PCPmust be in the Amerigroup network. Your PCP will give you a medical home. That means he or she willget to know you and your health history and be able to help you get quality care. Your PCP will give youall of the basic health services you need. He or she will also send you to other doctors or hospitals whenyou need special care. When you enrolled in Amerigroup Community Care, you should have picked aPCP. If you did not, we assigned one to you. We picked one who should be close by you. This doctor’sname and phone number are on your Amerigroup ID card.If we assigned a PCP to you, you can pick another one. Just look in the provider directory that came withyour enrollment package. We can also help you pick a doctor. Call Member Services for help. If you arealready seeing a doctor, you can look in the provider directory to see if that doctor is in our network. Ifso, you can tell us you want to keep that doctor.PCPs can be any of the following, as long as they are in the Amerigroup network:General PractitionersFamily ynecologists (OB/GYNs) (for women when they are pregnant)Advanced Registered Nurse PractitionersPhysician AssistantsA household may choose the same PCP for all household members enrolled with AmerigroupCommunity Care. They can also choose a different PCP based on each member’s needs.B-FLMHB-0002-11FL Medicaid 01.11 ENGPage 8

Second Medical OpinionAmerigroup members have the right to ask for a second opinion about the use of any covered health careservices. You can get a second opinion from a network provider or a non-network provider (if a networkprovider is not available). Ask your PCP to submit a request for you to have a second opinion. If a non-networkdoctor gives a second medical opinion, the member may have to pay up to 40 percent of the payment.Once approved, your PCP will let you know the date and time of the appointment. Your PCP will alsosend copies of all related records to the doctor who will provide the second opinion. Your PCP will letyou and Amerigroup know the outcome of the second opinion.If You Had a Different Doctor Before You Joined AmerigroupYou may have been seeing a doctor who is not in our network for an illness or injury before you joinedAmerigroup Community Care. In some cases, you may be able to keep seeing this doctor for care whileyou pick a new doctor. Please call Member Services to find out more about this. We will make a plan withyou and your doctor so we all know when you need to start seeing your new Amerigroup network doctor.If Your PCP’s Office Moves, Closes or Leaves the Amerigroup NetworkYour PCP’s office may move, close or leave the Amerigroup network. If this happens, we will call or sendyou a letter to tell you about this. In some cases, you may be able to keep seeing this PCP for care for upto six months if you are in a course of treatment. Please call Member Services for more informationabout this. Amerigroup will make a plan with you and your PCP so we all know when you need to startseeing your new Amerigroup network PCP. We can also help you pick a new PCP. Call Member Servicesfor help. Once you have picked a new PCP, we will send you a new ID card within 10 working days.How to Change Your PCPIf you need to change your PCP, you may pick another PCP from the network. Just look in theAmerigroup provider directory that came with your enrollment package. You can also find the providerdirectory online at www.myamerigroup.com. Amerigroup can also help you pick a doctor. Call MemberServices at 1-800-600-4441. We can change your PCP on the same day you ask for the change. Thechange will be effective immediately.You can also change your PCP online at www.myamerigroup.com.Call the doctor’s office if you want to make an appointment. If you need help, call Member Services. Wewill help you make the appointment.If Your PCP Asks for You to Be Changed to Another PCPYour PCP may ask for you to be changed to another PCP. Your doctor may do this if:Your doctor does not have the right experience to treat youThe assignment to your doctor was made in error (like an adult assigned to a child’s doctor)You fail to keep your appointmentsYou do not follow his or her medical advice over and over againYour doctor agrees that a change is best for youB-FLMHB-0002-11FL Medicaid 01.11 ENGPage 9

If You Want to Go to a Doctor Who Is Not Your PCPIf you want to go to a doctor who is not your PCP, please talk to your PCP first. In most cases, your PCPneeds to give you a referral so you can see another doctor. This is done when your PCP cannot give youthe care you need. Please read the section Specialists to learn more about referrals. If you go to a doctorthat your PCP has not referred you to, the care you receive may not be covered by Amerigroup.Picking an OB/GYNFemale members can see an Amerigroup network obstetrician and/or gynecologist (OB/GYN) forOB/GYN health needs. These services include well-woman visits, prenatal care, care for any femalemedical condition, family planning and referral to a special doctor within the network. You do not needa referral from your PCP to see your OB/GYN. If you do not want to go to an OB/GYN, your PCP may beable to treat you for your OB/GYN health needs. Ask your PCP if he or she can give you OB/GYN care. Ifnot, you will need to see an OB/GYN. You will find a list of network OB/GYNs in the Amerigroup providerdirectory that came with your enrollment package. You can also find the provider directory online atwww.myamerigroup.com.While you are pregnant, your OB/GYN can become your PCP. The nurses on our 24-hour Nurse HelpLinecan help you decide if you should see your PCP or an OB/GYN. If you need help picking an OB/GYN, callMember Services.SpecialistsYour PCP can take care of most of your health care needs, but you may also need care from other kindsof doctors. Amerigroup offers services from many different kinds of doctors who provide

If you think you are pregnant, call your PCP or OB/GYN right away. This can help you have a healthy baby. If you have any questions or need help making an appointment with your PCP or OB/GYN, please call Amerigroup Community Care Member Services at 1-800-600-4441. ALERT! Keep the Right Care. Do Not Lose Your Health care Benefits — Recertify