New Member Guide Welcome to your health journey - Dean Health Plan
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New Member Guide Welcome to your health journey
Contents Knowing the Ins and Outs of
Getting Started Your New Health Insurance
First Steps As a New Member 4–5
Insurance Questions or Concerns 6
Medical Questions or Concerns 7
Living Healthy Rewards 8-9
The Basics
Pay Your Premium or Bill 10-11
It’s important to know which Network
Find a Primary Car Provider (PCP) 12
you belong to because your network
Where To Go For Care 12-13
informs where you can go for care
Preventative Care 14 Product Type will determine
Resources for Traveling 15 where you can go for care
and the benefits associated
Specialty Care 16-17
with the plan
Medication Questions or Concerns 18-19
Plan Details Network: Dean
Group Number: XXXXXXXXXXXX
Life Changes and Insurance Changes 20 Product Type: HMO
deancare.com
Medicare Eligibility Or Additional Insurance 20
Filing a Grievance or Appeal 21 Member Name Member #
John Doe 012345678901
Privacy Information 21 Jane Doe 012345678902
Child Appointment Tips and Vaccine Information 22 Jack Doe 012345678903
Jill Doe 012345678904
Deductible*: Individual $XXXXX Family $XXXXX
Out of Pocket Max*: Individual $XXXXX Family $XXXXX
*Please refer to your plan materials for your additional financial responsibility.
Find us with ease PCN: 5104 • BIN: 610602
C u s t o m e rC a r e : 8 0 0 - 2 7 9 - 1 3 0 1 ( T T Y : 7 1 1 ) • N u r s e A d v i c e L i n e : 8 0 0 - 5 7 6 - 8 7 7 3
Keep the attached magnet
on your refrigerator!
Your Member ID Card
If you haven’t yet received your ID card,
We’re so Happy it should be on the way!
You Chose Dean Health Plan Out-of-pocket Max is the most
you will pay for your expenses
Your Deductible is the amount for medical care. These costs
Count on Dean Health Plan to have your back so you can stay healthy and get the most
you pay for covered health care aren’t reimbursed by insurance
out of your plan. As a member, you now have access to valuable resources to manage
services before your insurance and include deductibles,
your health and empower you to take control of your care. That means benefits you
plan starts to pay coinsurance and copayments for
can understand, tools that save you time and most importantly, support from our
knowledgeable staff whenever you need us. covered services plus all costs
for services that aren’t covered.
2 | New Member Guide: Get Started Visit deancare.com to find information on your benefits | 3
Like us? Follow us!
Starting a New Health Plan Can be Complicated
Follow us on LinkedIn and Facebook
We Make it Easy and leave us a Google review
Step 1: Activate your FREE accounts You Should Know
• See pages 6–9 for details Review important member documents.
• Schedule appointments, send secure messages to your provider and more • Your Member Certificate (sometimes called a “Member Policy”) has information about your
through your MyChart account insurance benefits and coverage, and it lists general limitations and exclusions to your plan
• Access your insurance details, view and pay your premium bill and more • Your Summary of Benefits and Coverage is an easy-to-read grid that lists the details
through your Member Portal of plan coverage, along with a basic cost estimate of your financial responsibilities for
• Achieve your goals for a healthy lifestyle and earn rewards along the way common medical services*
through the Living Healthy tile in the member portal •T
ake a moment to review common health insurance terms on pages 10–11
so you better understand your coverage
Step 2: Decide where you’d prefer to receive your primary care • The Pharmacy Drug Formulary is a list of prescription drugs that help you understand
what is and isn’t covered by your insurance
• Visit deancare.com to find a primary care clinic near you
isit your member portal at deancare.com/Account-Login for links to these
•V
Before you come in for your first visit, it’s a good idea to have your medical records member documents†
transferred from your previous primary care clinic to your new one. Contact your previous
clinic to obtain and complete an Authorization to Release Protected Health Information
Form. The form allows your previous clinic to send your medical records to your new clinic
so your medical team can best continue your care.
Do you have a chronic condition or a health concern?
•W
e’re here to support you if you have a serious condition or have a complex
health care need
Follow us on Facebook! • Visit deancare.com/ccmanagement to learn how we can help, or contact the
Customer Care Center
We’re sharing helpful insurance tips,
informative videos and much more.
Go to facebook.com/deanhealthplan
to join the conversation all year long.
*Y
our financial responsibilities may come in the form of a copay, coinsurance or deductible.
The terms stated in these documents may change at your annual policy renewal, and we
would send you an outline of any changes at that time.
† These documents are also available by contacting the Customer Care Center. To request
copies be mailed to you, see page 6 for contact details. If you receive health insurance
through your employer, you can ask your company’s plan administrator or benefits specialist
for your specific benefit and coverage information.
4 | New Member Guide: Get Started Visit deancare.com to find information on your benefits | 5
Health Insurance Support is Just Get in touch with us
a Tap or Click Away in Several Different Ways
24-Hour Nurse Advice Line
Save our number in your phone!
800-57-NURSE
You shouldn’t have to be a rocket scientist to figure out health insurance. We offer innovative Time is precious. When health concerns come up, call our nurses right away for real insight
tools to help you sort through all your information. And if you need a little help along the into your specific situation instead of generalities found on various internet sites.
way, we’re standing by.
SSM Health Express Virtual Care E-Visit
Get help for common illnesses like flu or sinusitis by connecting to a local
Member Portal Customer provider via smart phone or computer. Only certain conditions qualify
Care Center for a Virtual Care E-Visit. Visit deancare.com/evisit
MyChart**
Manage your medical world – all from a computer or smart phone.
Manage your health insurance Our friendly Customer Care Specialists
MyChart is designed for the way you live today.
information with your secure and are here to turn health insurance
convenient Member Portal account. confusion into clarity. • Send and receive secure messages with your primary care provider
• Schedule appointments
• View your insurance plan details •G
et answers to benefit
• Get lab results
and coverage questions
• Request member ID cards or • Request prescription refills and more
download a digital copy •F
igure out what your financial
• View and pay your medical bill
responsibility is for a bill
• Change your primary care clinic Visit deancare.com/mychart to activate your account.
• Learn the details about a provider
• Review past claim details and more
• View and pay your premium bill
Call 24-Hour Nurse Advice Hotline
800-279-1301 (TTY: 711) Take the guesswork out of getting the health care you deserve.
Visit deancare.com/login and use your Monday – Thursday, 7:30 am – 5 pm A nurse is ready to help 24/7/365.
member number from your ID card to Friday, 8 am – 4:30 pm
• Talk with an experienced registered nurse from SSM Health
activate your account. Click
Visit deancare.com • Get help figuring out where to go for care
and send us a message. • Get answers to your health-related questions or concerns
Visit Call 800-57-NURSE. Save our number in your phone so you can
Stop by our Insurance Desk, Monday – call us anytime.
Friday, 8 am – 4:30 pm, at our office
or one of the SSM Health Dean Medical Health Pandemics
Group locations.† If and when epidemics happen, Dean Health Plan will make every effort
to provide up to date information. For Coronavirus (Covid-19) updates,
please visit deancare.com/wellness/coronavirus.
* Please call 800-279-1302 if you purchased your coverage from the Health Insurance Marketplace.
† If necessary, these are offered by phone. ** Some features of MyChart may not be available at all primary care clinic locations.
6 | New Member Guide: Get Started Visit deancare.com to find information on your benefits | 7
Achieve Your Goals and Eating Well Made Simple with
Earn up to $150
For more information visit
deancare.com/wellness
We believe that with the right tools, information and motivation, you can achieve your goals Personalized Digital Nutrition
for a healthier lifestyle on your own terms. That’s what Living Healthy is all about. Visit
Do you want to eat healthier but feel you don’t have the time or energy for the planning,
deancare.com/livinghealthy to create your personalized Living Healthy portal account
shopping and preparation that’s involved? You’re not alone, which is why Dean Health
today.†
Plan teamed up with Foodsmart to offer you and your family a free program that makes
it easier to eat well. With Foodsmart, you can benefit from personalized recipes, powerful
meal-planning tools, grocery discounts and more to help you be a healthier you.
• Get recipes just for you
Living Healthy Rewards* Access recipes personalized to your dietary preferences, including quick meals
based on ingredients in your kitchen right now
Living Healthy Rewards 2022 will focus on Preventive Health Services!
Prevention or early detection of common diseases is the best way • Make meal planning quick, easy and done
to be the healthiest you. The list below includes some of the more Save time and stress with a digital meal planner, easy grocery list and, if you’d like,
common preventive and screening services proven to improve home delivery through Amazon Fresh, Walmart and Instacart (varies by location)
health, but it is important to check with your primary care provider to • Score fresh new deals
determine which tests are appropriate for you, based on your medical Save money with great discounts on healthy foods at your favorite local grocery stores
history and family history. Earn points for taking care of you!
• Immunizations: Influenza, Varicella, Tetanus,
Meningococcal and Pneumococcal Download the Foodsmart app from the Apple App Store
• Cancer screenings: Mammogram, Colon Cancer or Google Play Store, or visit deancare.com/foodsmart to sign up
(FIT testing, Cologuard, Colonoscopy) and PAP smear
• Other screenings: Chlamydia, Gonorrhea, HIV,
Hepatitis C, Diabetes and Depression
Here’s how it works:
• Choose the healthy activities you want to complete
• Each completed activity is worth reward points
• Earn up to 1,500 points for a maximum of $150 per calendar year
• Get your reward in the form of gift cards to your choice of many
national retailers, restaurants and other popular merchants
• All rewards must be redeemed before December 31, 2022
*Y
ou must complete the online health assessment in order to earn reward
points for other healthy activities. Only Dean Health Plan members, ages 18
and older, are eligible for Living Healthy rewards. Covered adult children
can earn up to $100 per year for completing healthy activities.
8 | New Member Guide: Get Started Visit deancare.com to find information on your benefits | 9
For more information, visit
Health Insurance 101:
Insurance Terms to Know deancare.com/billpay
We provide tools to know where your health care dollars go, and we try to make it as easy as
possible to understand your financial responsibilities.* Your policy may use a system of cost Payments and Claims
sharing that can include a copay, coinsurance, deductible or any combination of the three.
DEDUCTIBLE Estimate the cost for a service Submit a claim
1 Each time you receive medical services, you’ll pay the
bill towards these services up to a certain amount. This
amount is your deductible, which is what you must pay
Check your Member Policy document for
details about common medical services. You
may also visit deancare.com/cost-estimator
Claims are usually sent directly to Dean
Health Plan by providers or clinics.
Sometimes – if you’re traveling out of the
for covered health care services each year before we for three tools that estimate physician, area or have a college-age dependent, for
begin to pay. facility and pharmacy costs. example — it may be necessary for you to
submit a claim for reimbursement. Visit
COINSURANCE† Make a payment deancare.com and search the phrase:
2 2 Once you’ve paid the deductible amount, your insurance
will then start splitting the cost of additional medical
services with you. This is known as coinsurance, where
For insurance premiums: You can pay your
insurance premiums online or by mail. Visit
deancare.com/billpay to learn more.
“member paid claim reimbursement form.”
Be sure to follow these guidelines:
• Send an itemized bill from the provider of
1 you only pay a percentage or part of the total cost of
services and we’ll pay the rest.
For medical bills: When you are seen at a
clinic location for services, you may pay
service. If services were received outside
of the U.S., you will need to submit the
a copay when you check-in. SSM Health
Deductible and Coinsurance Limit – There’s a dollar original bill along with an itemized bill
will send you a bill for any copay charges that has been translated into English
limit to the amount you’ll pay towards your deductible
not paid at the time of service or any and indicate the appropriate currency
and coinsurance.
deductibles and coinsurance for which you exchange rate at the time the services
are financially responsible. You can pay your were received.
COPAYS
3
* Not all of the cost-sharing terms
listed here apply to all members.
bill online through your MyChart account
A copay is a fixed dollar amount, which you pay at the • Send the bill within 60 days (up to 12
Refer to your Member Policy or mail your payment (check or credit card
time you receive medical services (for things like an office months are allowed) after the services
document to understand info) with the enclosed payment form. Visit
which apply to you.
visit) and prescriptions. All your copays add up toward are received to:
deancare.com/billpay to learn more.
your Maximum Out-of-Pocket total.
Dean Health Plan,
† Coinsurance is your share of
the costs of a covered health
Maximum Out-of-Pocket – There’s a dollar limit to Explanation of Benefits (EOB) Attn: Claims Department
care service. It’s calculated as all your cost sharing. You reach this amount by means The EOB is not a bill. You’ll receive an PO Box 56099
a percent of the allowed of your deductible, plus your coinsurance, plus your EOB when you use your health plan for a Madison WI 53705-9399
amount for the service. copays. Once this limit is reached, you’ll pay nothing on covered service. The EOB lists the services
• If you have another insurance company
subsequent covered medical charges for the remainder of used, amount charged by the provider and
that is the primary payer, you will need to
your policy year. your financial responsibility to pay toward
send the Explanation of Benefits to Dean
Premium – the amount you pay each month to access deductibles or coinsurance. Log in to
Health Plan or your health care provider.
your health insurance. Member Portal to see your past EOBs
at deancare.com/login.
10 | New Member Guide: The Basics Visit deancare.com to find information on your benefits | 11The Best Relationships
Where to Go for Care Include a Healthy Dose of Trust
Still not sure of the type of care you need?
Call the 24-Hour Nurse Advice Line
at 800-576-8773.
A nurse is ready to help 24/7/365.
Know your care options before you need them
SSM Health Express Virtual Care Health care is a very personal – and at times, an intimidating – experience. That’s why our Care
SSM Health Express Virtual Care offers two convenient and affordable options for patients Teams work so hard to earn and keep your trust. No judgments. Just compassion.
to access non-emergent without scheduling an appointment. These services are available to
everyone, whether or not they are an established SSM Health patient.
Primary Care
Provider (PCP) Coordinated Care
e-Visit Video Primary Urgent Emergency
Visit Care Care Care Your Care Team is committed to working Dean Health Plan is part of an Integrated
with you to build a relationship of trust. Delivery Network (IDN) with SSM Health,
Trust combined with their training and which physicians, hospitals, health plans,
$ $$ $$$ experience means you have a true health and pharmacy care to reduce health care
Too sick to Prefer a Wish to see Primary care Life-threatening advocates who care. costs, improve quality and deliver a better
drive to the face-to-face your doctor clinic full or illness or injury? member and patient experience for you.
Your care team:
doctor? conversation? for care? closed? Go to the nearest • Consists of your primary care providers
Fill out Start a video Schedule an Visit your emergency room
an online visit and quickly appointment nearest Urgent or call 911. • Provides care for a wide range of
questionnaire, connect with at your primary Care facility. preventive and long-term health care
receive an SSM Health Heart attack,
care clinic. • Helps you stay healthier with regular visits,
a written provider. No When your stroke, head
Same-day immunizations and screenings
diagnosis, appointment normal clinic is injury, severe
treatment, and necessary. appointments
full or closed. pain. • Handles your immediate care needs
a prescription. are usually
Abnormal available. • Coordinates needed specialist care
Cold/flu, headaches,
In-person • Coordinates your health care
allergies, earaches,
lice, etc. chronic treatments with other medical experts
conditions, etc. and annual
Visit deancare.com/doctors to search our
checkups.
online provider directory for an available
All care subject to copay and deductible
primary care provider. You can filter your
search so you only see providers in your
if filed with insurance.
network. Then select a provider to learn
Learn more at
about his or her education, specialty, deancare.com/rightcare
We are here to help
Visit deancare.com/rightcare
or scan this QR code to start your visit
12 | New Member Guide: The Basics Visit deancare.com to find information on your benefits | 13Getting Sick Happens. Staying Healthy? Traveling?
We Help Make That Happen Too Here’s What You Need to Know
We do more than pay the medical bill. At the heart of our preventive care philosophy is You don’t need to take insurance coverage worries with you on your vacation.
a promise that you’ll get the support you need to remain as healthy as possible and help We have you covered for urgent and emergency care worldwide.
prevent disease.
Annual Preventive Visit Traveling Services
This type of visit can bring to light health concerns so they can be addressed • We’ll cover services provided in an urgent care facility and/or emergency
before they get worse. That’s what preventive care is all about. room while you’re out of the Dean Health Plan service area, subject to
policy copayments, coinsurance, deductibles and maximum allowable fees.
• Allows your primary care provider to get to know you
No referral or prior authorization needed. If you are unable to get to an in-
and your health care needs
network plan provider, please go to the nearest urgent care or emergency
• Helps you prevent or manage illnesses, diseases or other center for treatment. Please notify us as soon as possible by calling the
health problems Customer Care Center at 800-279-1301 (TTY:711).
• Includes important preventive services, such as patient counseling, referrals • An in-network provider should resume all follow-up care. If you are out of
to specialists and recommendations for other preventive care to get (see the area and not able to see an in-network plan provider, call your primary
below for examples) care provider to discuss the urgent/emergent services you received
and the recommended follow-up with an out-of-network provider. You
must have an approved prior authorization for services to be covered.
Your primary care provider will submit a request for medically necessary
services with the out-of-network provider.
Preventive Care*
In addition to an Annual Preventive Visit for all ages, we encourage Need a Ride to See Your Provider?
and cover: No problem! Your ride. Our cost. At Dean Health Plan, we know that getting
• Immunizations - doses and age-specific vaccines vary access to care when you need it is important. That’s why we have partnered
with Lyft to do the driving.
• Screenings for breast, cervical and colon cancer
To support our members in managing their health, we are offering our
• Annual Sexually Transmitted Infection (STI) counseling
individual and family plan* members a free ride to and from any medical
for adults and adolescents
appointments with their providers during clinic hours.
• Cholesterol screening for all ages and more
For more details and to schedule your ride, call our Customer Care team
Visit deancare.com/preventivecare for a complete list of covered at 800-279-1302 (TTY: 711) or visit deancare.com/lyft
preventive services.
* Information presented here is meant to supplement – not replace – the advice and care of health *Individual and family members who use Lyft transportation will need access to the Lyft mobile
care professionals. To see your specific preventive care coverage details, please review your app on a smart phone, and have an account to set up their rides. To set up an account with Lyft,
Member Certificate (sometimes called a “Member Policy”) and Summary of Benefits and Coverage download the app from the App Store or Google Play, or visit Lyft’s website to sign up today. Lyft
documents. Details for covered preventive services may change. is taking extra precautions during the COVID-19 crisis; review their guidelines before scheduling.
For coverage questions, contact the Customer Care Center. See page 6 for contact details.
14 | New Member Guide: The Basics Visit deancare.com to find information on your benefits | 15Have a question?
Specialty Care is Everywhere
Contact the Customer Care Center.†
When You Need it 800-279-1301 (TTY: 711)*
In addition to primary care providers, our network includes a variety of medical specialties. Do You Need Prior Authorization?
Your primary care provider can help you find the specialist who is right for you.
My PCP (or other in-network provider) recommended I visit a specialist:
Specialty Care 101
Talk with your primary care provider if you think you need to be seen
by a specialist.
HMO or Focus Plan
• Examples of specialty care include physical therapy, podiatry,
chiropractic services and dermatology
In-Network Out-of-Network
• There are many specialists affiliated with Dean Health Plan, including
but not limited to SSM Health
You don’t need to do anything. Yes, you need to get prior authorization to see
• You should be seen by a specialist within the Dean Health Plan Although the service may require a an out-of-network provider. Discuss this with
network of providers prior authorization, it is up to your your plan physician and he or she will submit
Visit deancare.com/doctors for a comprehensive list of our specialty in-network provider to get prior an authorization to the health plan if the
providers, behavioral health services and hospitals. authorization for you. services are not available with plan providers.
We’ll then review the request and provide a
written decision to both you and the referring
Prior Authorization provider within 15 calendar days from receipt.
Certain medical services or specialty care services from a specialty Make sure you wait until you receive this
provider might require you to get prior authorization.* approval before receiving the recommended
services to avoid any unnecessary fees.
• A good rule to remember is that any time you seek services with an out-
of-network provider, you will need to get prior authorization unless your
benefit plan includes an out-of-network option
PPO or POS Plan
• We require prior authorization so our medical management team can
review the medical necessity of the recommended service or visit and
make sure you are getting appropriate care unless your benefit plan Because each POS and PPO plan is different, we recommend
includes an out-of-network option you check to see if a prior authorization is required for any
services outside of a normal office visit. For a plan-specific list
of these services, refer to the “Prior Authorization” section of
For a plan-specific list of services your Member Certificate (sometimes called “Member Policy”)
available at deancare.com/member-benefits. You may also call
that require a prior authorization,
800-279-1301 (TTY:711) for help.
please visit deancare.com/
member-benefits
* A prior authorization can only be obtained for services that are covered under your plan benefits. For example, if † If the Customer Care Center is unable to address your authorization concerns, you will be connected to the Care
bariatric surgery isn’t covered in your policy, prior authorization will not change the policy to cover it. If the services Management Department. If you have an urgent need outside of business hours, leave a message with the Customer
are covered under your plan, they remain subject to a decision regarding medical necessity and any applicable cost Care Center and your call will be returned within one business day.
sharing (e.g., copays, coinsurance or deductibles).
16 | New Member Guide: The Basics Visit deancare.com to find information on your benefits | 17Getting the Most
From Your Drug Benefit
Find a pharmacy location near you:
deancare.com/pharmacy
Convenience and member affordability are the name of the game when it comes to Dean
Health Plan pharmacy services. We’re here to help you manage your prescriptions and lower
your expenses.
SSM Health Pharmacies & FREE Delivery Specialty Pharmacy
Our friendly and professional staff are available at eight convenient Medications for many chronic and complex health conditions can be hard
locations. to manage. Lumicera, our Specialty Pharmacy, works with you and your
provider to help you to manage your condition and to make sure you
• Get answers to your questions and make sure your
receive the best care possible. We offer free delivery, same-day service,
medications are right
refill reminders, financial assistance and more.
• Refill prescriptions by phone or online
• Pickup prescriptions or receive FREE mail-order delivery
Drug Formulary & Management Procedures
from Costco Mail Order Pharmacy to your door
We use a drug formulary, which is a list of prescription drugs that helps
(within the continental US)*
you understand what is and isn’t covered. Our drug formulary breaks the
• Get prescriptions filled for 90 days list into different tiers. The tiers are organized by the level of cost sharing
between you and the health plan. The drug formulary is reviewed every
Visit deancare.com/pharmacy to view your drug formulary, find nearby month and updated on a regular basis. For example, we update the drug
pharmacies and learn more about mail-order delivery, immunizations formulary when a new generic drug is approved. There are restrictions to
and other pharmacy services. and procedures for your coverage in order to help keep plan costs down.
Restrictions to and procedures for your prescription coverage mean you
Costco Pharmacy may only receive drugs listed on our drug formulary (closed formulary).
Our Preferred Mail Order Pharmacy Certain drugs may have specialist restrictions or require you to visit a
Interested in having your prescriptions delivered? You can order all your specialty pharmacy. You may also be required to have prior authorization,
prescriptions through the Costco Pharmacy! A Costco membership is not mandatory generic substitution, step therapy and quantity level limits for
needed to use their mail order pharmacy. certain drugs. Be familiar with your plan’s specific coverage details and
visit deancare.com/pharmacy to review our drug formulary, along with
To switch to Costco, members will need to register with Costco Mail general limitations and procedures.
Order Pharmacy. They can register by visiting pharmacy.costco.com
and clicking “Sign In/Register.”
You will also need your prescriber to submit new prescriptions to Costco.
For more information about our Mail Order Pharmacy program, contact
our Customer Care Center at 800-279-1301 (TTY: 711).
* Mail-order delivery service is not available to all members. Refer to your Summary of
Benefits and Coverage document or contact the Customer Care Center. See page 6 for
contact details.
18 | New Member Guide: The Basics Visit deancare.com to find information on your benefits | 19We Can Help Member
Make Changes to Your Plan Information
Special Enrollment Let us know if you have other Member Rights & Responsibilities Terms & Conditions
We understand that sometimes big events coverage or Medicare. You deserve the best service and health care All your benefits are subject to terms and
happen in your life and it means you need to Do you have health insurance coverage in possible. Rights and responsibilities help foster conditions as described in your Schedule of
make a change to your coverage with Dean addition to your coverage through Dean Health cooperation among members, providers and Dean Benefits and in your “Member Policy.” Please
Health Plan. You can make changes to your plan Plan? When you have coverage through more Health Plan. Visit deancare.com/member-rights to refer to these important documents for
outside of the designated open enrollment period than one source, we have to determine in view all of your member rights and responsibilities. complete details.
(whether you purchased coverage on or off the what order claims will be paid, referred to as
Health Insurance Marketplace), but only if you coordination of benefits. It is especially important Grievance & External Independent Drugs and New Medical
have a qualifying event that would trigger a that you notify us when you are eligible for Review Rights Technology
special enrollment period.* Medicare. When you are eligible for Medicare, We know that at times you may have questions Each year, we evaluate new and existing medical
Please review our special enrollment page at Dean Health Plan processes your claims as if you and concerns about benefits, claims or services technology to determine if any updates to medical
deancare.com/specialenrollment for more are enrolled in Medicare, even if you choose not you have received from Dean Health Plan. When policies are needed. Drugs covered under your
information on qualifying event requirements. to enroll in Medicare Part A and/or B. This will a question or concern arises, we encourage you pharmacy benefit are also reviewed by a Dean
result in you paying out-of-pocket for services to reach out to our Customer Care Center. Our Health Plan medical director and pharmacists
that Medicare would have covered. For this Customer Care Specialists will make every effort from SSM Health System and Navitus Health
reason, we strongly suggest that you enroll to resolve your concern promptly and completely. Solutions. Dean Health Plan follows the review
in Medicare Part A and B as soon as you Your input matters, and we encourage you to call process set forth by the National Committee for
are eligible.† with any concerns you may have regarding your Quality Assurance (NCQA) any time there is a new
We’re here to help you sort it all out. If you health care. If after contacting us, you continue product or process. Based upon the results of
are enrolled in Medicare or have questions to feel a decision has adversely affected your the technology assessment, Dean Health Plan
about Medicare, please contact the Medicare coverage, benefits or relationship with Dean will revise its medical policies if necessary.
Coordination of Benefits Specialist at Health Plan, you may file a grievance or appeal.
Privacy & Confidentiality
608-827-4189 (TTY:711). To report additional
Visit deancare.com/appeals for details on Dean Health Plan is required by law to
coverage other than Medicare, please call
how to file or for more information about these maintain the privacy of your personal health
the Customer Care Center at 800-279-1301
procedures. You may also find information in your and financial information (collectively
(TTY:711).
Member Certificate or Summary. Contact the referred to as “nonpublic personal
Customer Care Center with any questions about information”) and provide you with written
the process. See page 6 for contact details. notification of our legal duties and privacy
practices concerning that information.
How to Submit a Complaint
* Special enrollment periods, which were created by the † You are Medicare-eligible if you are a legal U.S. resident and
If you have a complaint, please contact our Please visit deancare.com/privacy or call
Affordable Care Act (ACA), give consumers a limited time one of the following applies to you:
period after a qualifying event to purchase new individual • You are age 65 or older Customer Care Center at 800-279-1301 (TTY: 800-279-1301 (TTY:711) to request a copy.
health insurance or make changes to an existing policy, • You are any age and have a qualifying permanent disability 711). We will document and investigate your
like adding a dependent or changing plans. • You are any age and have been diagnosed with end-stage
complaint and notify you of the outcome. For
renal disease (ESRD)
more information, visit deancare.com/appeals.
20 | New Member Guide: Plan Details Only for individual plans (for example,
Visitpurchased throughtothe
deancare.com Marketplace)
find information on your benefits | 21For more information, visit
Child Appointment Tips and
Vaccine Information deancare.com
When it comes to medical appointments for your child, a few minutes of preparation can
make a big difference.
Helpful Tips
Here are some helpful tips for you and your child to have a successful
experience with your child’s Primary Care Provider.
• Be honest and tell your child what to expect. For example, you could say that
immunizations will hurt, but only for a minute or so.
• Use a toy or musical instrument to distract your child during shots or other
uncomfortable moments. Let them know it’s okay to cry.
• Talk with other people who know your child well, such as a grandparent
or caregiver, and ask if they have any health concerns
Do you or your child need to catch up on any vaccines?
Visit cdc.gov/vaccines/schedules to view the Catch-Up immunization Schedule and learn
more about vaccines. To learn more about important immunizations and to check which
vaccines your family members have received in the past, visit the Wisconsin Immunization
Registry at dhfswir.org
Are you in need of a COVID-19 vaccine?
Schedule yours today at ssmhealth.com/access/covid19-vaccine-scheduling
22 | New Member Guide: Plan Details Visit deancare.com to find information on your benefits | 23We’re so happy you chose
Dean Health Plan!
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Madison WI 53705-9399
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