HIPAA Compliance

Privacy

AmeriHealth is committed to protecting the privacy of our members’ personal health information. Part of that commitment is to comply with the privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). That rule sets standards for covered entities, such as AmeriHealth, to protect personal health information and allow an individual access to his or her personal health information.

AmeriHealth has completed activities required for compliance with the privacy rule and has implemented policies and procedures necessary to protect the privacy of our members’ personal health information.

For more information contact the Privacy Office.

Administrative Simplification

HIPAA also requires that all payers be capable of performing transactions electronically if requested by providers, groups, or insurance companies; and that transactions must use a standard “HIPAA-compliant” format with regard to file formats, codes, identification numbers, etc. Examples of transactions that fall under these regulations include enrollment records, eligibility information, premium payments, claim submissions, and claim status.

AmeriHealth completed all internal system changes and processes to accept and handle the required electronic transactions.

Security

The HIPAA regulations also include a security rule. Effective on April 21, 2005, the security rule set the standard to ensure the privacy of electronic protected health information. AmeriHealth has implemented the requirements of the rule and continually monitors and manages the required security controls. AmeriHealth continues to implement new technologies that improve the security of infrastructure beyond the requirements of the HIPAA security regulation.

For more information contact the Security Office.

You must continue to pay your Medicare Part B premium.

The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions.

Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
• Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor AmeriHealth 65 NJ HMO will be responsible for the costs.

Please contact AmeriHealth 65 HMO for more information.

In lots of cases, your prescriptions are covered under AmeriHealth 65 NJ HMO, AmeriHealth Rx PDP if they are filled at a network pharmacy or through our mail-order pharmacy service. There are thousands of network pharmacies, including:

• national chain and independent retail pharmacies
• long-term care and home-infusion pharmacies
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Program pharmacies

Website last updated: 12/30/11
Y0041_HNS_12_301a Pending CMS Approval