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CIGNA-HEALTHSPRINGSTAR PLUSMember HandbookHidalgo Service Area:Cameron, Duval, Hidalgo, Jim Hogg,Maverick, McMullen, Starr, Webb,Willacy and Zapata CountiesMedicaid Rural Service Area(MRSA) - Northeast:Anderson, Angelina, Bowie, Camp,Cass, Cherokee, Cooke, Delta, Fannin,Franklin, Grayson, Gregg, Harrison,Henderson, Hopkins, Houston, Lamar,Marion, Montague, Morris, Nacogdoches,Panola, Rains, Red River, Rusk, Sabine,San Augustine, Shelby, Smith, Titus, Trinity,Upshur, Van Zandt and Wood CountiesDecember 20151-877-653-0327 (TTY: 7-1-1)Monday to Friday, 8 a.m. to 5 p.m. Central Time2208 Hwy 121, Suite 210, Bedford, TX bookTarrant Service Area:Denton, Hood, Johnson, Parker,Tarrant and Wise CountiesIf you have questions about your Member Handbook or your benefits, please call Cigna-HealthSpring Member Services at 1-877-653-0327. We are available Monday to Friday,8 a.m. to 5 p.m. Central Time. For the Hearing Impaired, please call TTY: 7-1-1. All Cigna products and services are provided exclusively by or through operating subsidiaries ofCigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.MCDTX 16 40817 04202016 2016 Cigna

We are here to help in every wayCongratulations on choosing Cigna‑HealthSpring as your STAR PLUS plan.We thank you for your membership. Our team looks forward to helping you improve your health, well‑beingand sense of security. At Cigna‑HealthSpring, our goal is to give you more from life. This includes helping youget quality care that is affordable, easy to understand and tailored to meet your individual needs.This Member Handbook can help you get the most from your STAR PLUS plan. It isimportant to read it carefully and keep it in a safe, convenient place.Introduction to Cigna‑HealthSpringWELCOME TOBETTER HEALTHYou will learn many important things from your Member Handbook, such as:››What is the role of your main doctor or Primary Care Provider (PCP)››How to find out what drugs are covered on the preferred drug list››When you need a referral or prior authorization from your main doctor››Who to call and what to do if you become ill or injured››How to take advantage of preventive health services and other benefitsAt Cigna‑HealthSpring, we want you to be involved in your own health. This means you need to followthe advice of your main doctor (Primary Care Provider). It also means you should call us when you havea question about your health plan. We are always ready to guide you in the right direction.Our team is your team. We are here to help you. If you have questions about your STAR PLUS plan, pleasecall Member Services at 1‑877‑653‑0327, Monday to Friday, 8 a.m. to 5 p.m. Central Time. If you havequestions about your health, you can call the nurses at our 24‑Hour Nurse Line at 1‑855‑418‑4552.On behalf of the entire Cigna‑HealthSpring family in Texas and beyond, I welcome you. We look forward tohelping you lead a healthier life.Healthy regards,Jay L. HurtTexas Division PresidentCigna‑HealthSpring Life & Health Insurance Co., Inc.P.S.Please let us know if you would like yourMember Handbook in audio, larger print, brailleor another language. We are happy to help.a

Important phone numbersCALL USWHEN YOUNEED HELPIt is important that you know where to turn when you need help.Your team is ready to guide you in the right direction. If youhave a health question or concern, you can call the nurses at our24‑Hour Nurse Line at 1‑855‑418‑4552. If you need helpor information, call Member Services at 1‑877‑653‑0327.You can also reach our mental health crisis line 24 hours aday, 7 days a week by calling 1‑800‑959‑4941.››Monitor your progress toward your health care goals.You can call your Cigna‑HealthSpring Service Coordinatorat 1‑877‑725‑2688. You can also call your ServiceCoordinator through Member Services at 1‑877‑653‑0327.Behavioral health andsubstance abuse servicesFor questions about behavioral health and substance abuse, callthe behavioral health line at 1‑877‑725‑2539. If you have amental health crisis, you can get help by calling our mentalhealth crisis hotline at 1‑800‑959‑4941, 24 hours a day,and 7 days a week. Qualified mental health professionalswill be ready to:››Answer your questions.››Assess your mental health.››Provide and coordinate services as needed.Bilingual or interpreter servicesImportantIf you have a life‑threatening emergencyor an emergency that poses a threat to thelife or property of others, call 9-1-1 or godirectly to the nearest emergency room.Cigna‑HealthSpring representatives are ready to help inEnglish and Spanish. Other language interpreter servicesare ready upon request. Cigna‑HealthSpring can provideinterpreter and translation services in over 170 languages.Cigna‑HealthSpring Member ServicesYou can get immediate answers to questions aboutyour benefits, the provider network or any other issuesrelated to your plan. Please call Member Services at1‑877‑653‑0327, Monday to Friday 8 a.m. to 5 p.m.Central Time, excluding state‑approved holidays.Bilingual or interpreter servicesCigna‑HealthSpring representatives are ready to help in Englishand Spanish. Cigna‑HealthSpring can provide interpreterand translation services in over 170 languages. Please callMember Services at 1‑877‑653‑0327 for assistance.Hearing impairedIf you are hearing‑impaired, please call TTY: 7-1-1.For more services, please call TTY/Texas Relayat 1‑800‑735‑2989 (English) or1‑800‑662‑4954 (Spanish).24‑Hour Nurse LineCigna‑HealthSpring gives you access to experienced registerednurses 24 hours a day, 365 days a year. Our nurses offerimmediate, reliable information for any health concern. Pleasecall 1‑855‑418‑4552. Help is ready in English or Spanish.Eye careIf you call after‑hours, on a weekend or holiday, you can leave avoice message. We will return your call on the next business day.Members eligible for Medicaid only can get routine eye careservices by calling Superior Vision at 1‑800‑879‑6901.If you need eye care for an illness or injury to your eye,call your main doctor for help first. You do not need areferral for specialty eye care from an ophthalmologist.Service CoordinationDental careAfter‑hoursCigna‑HealthSpring provides Service Coordination. Youand your Service Coordinator will work together to:bPlease rememberIf you have a life‑threatening emergencyor an emergency that poses a threat to thelife or property of others, call 9-1-1 or godirectly to the nearest emergency room.››Assess your health needs.››Create a care plan.››Organize all your services.Members eligible for Medicaid only who are 21 years of ageor older can get routine dental care services. STAR PLUSWaiver Members are also eligible for some dental care. To getcovered dental care, call DentaQuest at 1‑855‑418‑1628.

Ombudsman Managed Care Assistance Team:1‑866‑566‑8989 (TTY: 1‑866‑222‑4306)STAR PLUS help line:1‑800‑964‑2777Medical transportation servicesTo set up routine medical transportation, please calltoll‑free 1‑877‑633‑8747 if you live in the Hidalgoor MRSA‑Northeast service areas. If you live in the Tarrantservice area, call toll‑free 1‑855‑687‑3255.Don’t forgetYour satisfaction is very important to us. If you have anyconcerns, please let us know. We will be happy to help.Member Handbook informationImportant phone numbersOmbudsman and STAR PLUS2208 Hwy 121, Suite 210 Bedford, TX 76021Cigna‑HealthSpring Member Services1‑877‑653‑0327 (TTY: 7-1-1)Monday to Friday,8 a.m. to 5 p.m. Central TimeStarPlus.MyCignaHealthSpring.comQuick Reference GuideMember Services1‑877‑653‑0327Dental care1‑855‑418‑1628Bilingual/interpreter services1‑877‑653‑0327Ombudsman ManagedCare Assistance Team1‑866‑566‑8989Member Services forhearing impaired TTY7-1-1Ombudsman ManagedCare Assistance Teamfor hearing impaired1‑866‑222‑4306TTY/Texas Relay English1‑800‑735‑2989STAR PLUS help line1‑800‑964‑2777TTY/Texas Relay Spanish1‑800‑662‑4954Service Coordination1‑877‑725‑2688Behavioral health andsubstance abuseMedical transportationservicesHidalgo or MRSA‑Northeast service nt service area1‑855‑687‑3255Mental health crisis1‑800‑959‑4941Medicaid mental health/drug/alcohol help1‑877‑966‑378424‑Hour Nurse Line(English/Spanish)1‑855‑418‑45522‑1‑1 Help in Texas2‑1‑1 orwww.211texas.orgEye care1‑800‑879‑6901Medicaid prescriptionhelp line1‑877‑653‑0327c

Table of contentsIntroduction to Cigna‑HealthSpring aImportant phone numbers bCigna‑HealthSpring Member Services bBilingual or interpreter services bHearing impaired bAfter‑hours bService Coordination bBehavioral health and substance abuse services bBilingual or interpreter services b24-Hour Nurse Line bEye care bDental care bOmbudsman and STAR PLUS cMedical transportation services cMember Handbook information cCigna‑HealthSpring Member Services cQuick Reference Guide cWelcome to Cigna-HealthSpring 1What is Cigna‑HealthSpring? 1What does Cigna‑HealthSpring do? 1How has Cigna‑HealthSpring changed? 1What makes Cigna‑HealthSpring unique? 1What does Cigna‑HealthSpring offer? 1Your Cigna-HealthSpring ID card 2How to use your ID card 2How to read your ID card 2How to replace your ID card 3Your Texas Benefits Medicaid card 4Temporary verification form (Medicaid form 1027‑A) 5Your main doctor 6What is a Primary Care Provider (PCP or main doctor)? 6How do I pick my main doctor? 6What type of provider can I pick as my main doctor? 6Can a specialist ever be considered a Primary Care Provider? 6Can a clinic be my Primary Care Provider? (Rural health clinic/federally qualified health center) 6How can I change my Primary Care Provider? 6How can I change my Primary Care Provider if I receive Medicare benefits? 6How many times can I change my/my child’s Primary Care Provider? 6When will my Primary Care Provider change become effective? 6Are there any reasons why a request to change a Primary Care Provider may be denied? 7What do I need to bring with me to my doctor’s appointment? 7Can my Primary Care Provider move me to another Primary Care Provider for non‑compliance? 7What if I choose to go to another doctor who is not my Primary Care Provider? 7