On truehealthnewmexico.com, you can view and download all essential health plan information and documents. Our website has a lot of information, so use this chart to help you locate what you need. truehealthnewmexico.com/member -pharmacy-formulary • Our formulary (drug list) along with restrictions and preferences. • Information on drug coverage and any copayments you’re responsible for. • An explanation of limits and quotas. • Our pharmacy procedures, such as prior authorization, and how to use them. • How to receive coverage for non-formulary drugs. What a pharmacy exception is and how providers can provide information to support one. • Our processes for generic substitution, therapeutic interchange and step therapy. truehealthnewmexico.com/find-a-doctor • Information about network providers and their professional qualifications, including specialty, medical school attended, residency completed and board certification status. • Search for a doctor by zip code, city, gender and language spoken. • Search for a hospital or other medical facility. truehealthnewmexico.com/seeking -healthcare-services • How to choose and access a primary care provider (PCP). How to obtain primary care services. • How to obtain specialty care and behavioral health services and hospital services. • How to obtain care after normal office hours. • How to obtain emergency care, including our policy on when to go to the ER or call 911. truehealthnewmexico.com/out-of-state-coverage • How to obtain care and coverage when you are outside of our service area. truehealthnewmexico.com/get-language-assistance • How to obtain language assistance to talk with us. • The availability of TDD/TTY services. truehealthnewmexico.com/appeals-and-grievances • How to appeal a decision that adversely affects your coverage, benefits or relationship with us. • A description of the independent external appeals process for our utilization management decisions. truehealthnewmexico.com/member-rights -and-responsibilities • Our member rights and responsibilities statement. truehealthnewmexico.com/member-forms • How to submit a claim for covered services, if needed. truehealthnewmexico.com/contact-us • How to contact staff if you have questions about how we manage care and services. truehealthnewmexico.com/care-management • Information about our Case Management Program and Disease Management Program, and how you or your caregiver may self-refer to them. truehealthnewmexico.com/quality-improvement -program-members • Information about our Quality Improvement Program, including goals, processes and outcomes as related to care and service. truehealthnewmexico.com/health-wellness • Information about our no-cost health and wellness programs, such as True You. • Tools and other resources to help you improve your health. truehealthnewmexico.com/individual-family -plan-documents truehealthnewmexico.com/small-group-forms truehealthnewmexico.com/large-group-forms (Look in the Evidence of Coverage and the Summary of Benefits and Coverage for your plan.) • Information about benefits and services included in, and excluded from, coverage. Copayments and other out-of-pocket costs. Restrictions on benefits that apply to services obtained outside our system or service area. • How to voice a complaint. • Our policy prohibiting financial incentives for utilization management decision-makers. • How we evaluate new technology for inclusion as a covered benefit. truehealthnewmexico.com YOUR HEALTH PLAN INFORMATION AT YOUR FINGERTIPS { R E S O U R C E S }
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