Withdraw From 17 Voluntary Counties Serving the Medicaid Population on September 30, 2010
IMPORTANT NOTICE
July 8, 2010
Dear Medicaid Member:
Gateway Health Plan® has made the difficult decision to no longer provide healthcare coverage as of October 1, 2010 for our Medicaid members who reside in the following 17 Voluntary Counties.
- Cambria
- Carbon
- Clarion
- Columbia
- Franklin
- Jefferson
- Lackawanna
- Luzerne
- Mercer
- Monroe
- Montour
- Northumberland
- Pike
- Schuylkill
- Somerset
- Susquehanna
- Wyoming
If you live in Blair or Erie counties, this change does not affect you. Both Blair and Erie counties will remain part of the Gateway’s Voluntary County service area. In addition, Gateway will continue to provide benefits to Medicaid recipients in all of the following 22 HealthChoices Counties.
- Adams
- Allegheny
- Armstrong
- Beaver
- Berks
- Blair
- Butler
- Cumberland
- Dauphin
- Erie
- Fayette
- Greene
- Indiana
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Northampton
- Perry
- Washington
- Westmoreland
- York
Also, please be aware that this change WILL HAVE NO EFFECT on Gateway Health Plan Medicare Assured® HMO SNP members residing in the Voluntary Counties or other counties currently in the service area. Gateway Health Plan Medicare Assured® HMO SNP, a Special Needs Plan for those eligible for both Medicare and Medical Assistance, WILL continue to provide coverage for dual eligibles in the following 27 Counties:
- Adams
- Allegheny
- Armstrong
- Beaver
- Berks
- Blair
- Butler
- Cambria
- Cumberland
- Dauphin
- Erie
- Fayette
- Indiana
- Lackawanna
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Mercer
- Northampton
- Northumberland
- Perry
- Schuylkill
- Somerset
- Washington
- Westmoreland
- York
If you are a current member living in one of the 17 Voluntary Counties where service will no longer be provided as of October 1, 2010, you received notification regarding this change in your healthcare coverage and instructions on how to enroll with a new MCO or ACCESS Plus. If you have questions, please call the Enrollment Services line to enroll in another plan or ACCESS Plus. The toll free number is 1-800-440-3989 (TTY 1-800-618-4225).
Remember! If you are receiving an active course of treatment for a medical condition, have services that are prior authorized or are pregnant and need help with your health care services before you switch to a new health plan, just call the Gateway Health Plan® Member Services toll free at 1-800-392-1147 (TTY 711). Gateway Health Plan® Member Services is ready to help 24 hours a day, 7 days a week.
Gateway Health Plan® was the first Medicaid managed care plan to be awarded an ‘Excellent' rating from NCQA (National Committee for Quality Assurance) and has received this rating for more than 12 years.
No co-payments on PCP, Dental and OB/GYN visits. No limits on PCP and OB/GYN visits.
Large network of providers to serve you. Members enjoy access to over 8,000 participating doctors, 110 participating hospitals and nearly 3,000 participating pharmacies.
Eyeglasses or contacts for adults, too. Members get routine eye exams and can choose from a selection of frames for prescription eyewear at no cost.
Member Services to help you at home or while away. Members have access to member service staff 24 hours a day, 7 days a week ready to help. If you get sick when you are out-of-town, simply call our toll-free number at 1-800-392-1147. You will be connected to your doctor at no cost to you.
Drug Benefit. With a prescription, members can get vitamins, over-the-counter (OTC) medicines like cough and cold medicines and diabetic supplies. Your medical assistance category determines your coverage for other prescription drugs.
Special programs to help keep you healthy. If you are pregnant, have asthma, diabetes, or heart problems, you can get extra help to stay healthy. You will also have a nurse case manager to answer questions and arrange the extra support you need.
- MOM Matters® for Pregnant Women gives you the support you need to have a healthy baby.
- "AIR" Gateway® helps members keep asthma under control.
- Help Your Heart program helps adult members with congestive heart failure, a heart attack or coronary artery disease.
- Healthy Returns diabetes program helps members with diabetes and their families understand how diet and medication can keep blood sugar under control.
Dental care for everyone. All members receive routine and preventive dental care such as exams, cleanings and x-rays. Additional dental services are available to members who qualify.
If you would like information about Gateway Health Plan®'s Quality Improvement Program please contact Member Services at 800-392-1147.
All information/materials on this website can be requested in hard copy by calling Member Services at 800-392-1147.
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