B Initial Health Plan Enrollment

Policy

Within 10 days of enrollment, the health plan provides the customer with:

·        Printed information about the health plan’s services and service locations;

·        The name, address, and telephone number of the customer’s primary care provider (PCP); and

·        Information on how the customer may change PCPs

Customers receive an AHCCCS Medical Assistance ID card in the mail that includes the health plan’s contact information. Customers must present this ID card whenever medical services are requested or provided (ex., doctor’s office, hospital, lab, or pharmacy). Customers who do not receive an ID card should call their health plan.

Most customers who do not currently have AHCCCS coverage have a choice of health plans that serve their Geographic Service Area (GSA). 

When a customer does not choose a health plan before the application is approved, AHCCCS automatically assigns a health plan and enrolls the customer. The customer is sent a Freedom of Choice letter informing them of the health plan they were assigned and giving them a 90-day period to choose a different health plan. When the customer does not contact AHCCCS to choose a different health plan, the customer remains enrolled with the auto-assigned health plan.

NOTE    American Indians customers living within the bounds of the tribal nation that do not choose a plan will be automatically enrolled in AIHP.

Exceptions:

The following customers do not have a health plan choice:

·        Customers diagnosed with a Serious Mental Illness (SMI);

·        Children in State of Arizona foster care; and

·        Customers who were enrolled with a health plan within 90 days before the new approval, AND that health plan remains available in the customer’s GSA.

Customers that need help selecting a health plan may:

·        Visit www.azahcccs.gov/choice; or

·        Speak to a Beneficiary Support Specialist by calling (602) 417-7100 from area codes (480), (602), and (623) or 1-(800) 334-5283 from area codes (520) and (928).

Definitions

Legal Authority