|
|
In general, customers enrolled in a health plan may change their enrollment once a year during their enrollment choice month.
The enrollment choice month is the month in which the customer was first enrolled with an AHCCCS Complete Care (ACC) plan. During the enrollment choice month, a customer can change their health plan by:
· Electronically submitting requests using https://www.healthearizonaplus.gov; or
· Calling (602) 417-7100 from area codes (480), (602), and (623) or 1-(800)-334-5283 from area codes (520) and (928).
Customers who do not want to change their health plan do not have to do anything to remain enrolled with the current health plan.
When a customer does change health plans, the month after the enrollment choice month is the transitional month. During this time AHCCCS notifies both the current health plan and the new health plan of the enrollment change. This allows the health plans time to transfer records and welcome new members.
When more than one person in a household receives AHCCCS Medical Assistance, an enrollment choice month is assigned to the household using the enrollment choice month of the customer that has been on AHCCCS for the longest time. All customers in the household who want to change health plans may do so at that time.
Exceptions:
The annual enrollment process does not apply to any of the following customers:
· Foster care children enrolled with Mercy Care Department of Child Safety Comprehensive Health Plan (DCS CHP); and
· Customers diagnosed with a Serious Mental Illness.
When customers need help selecting a health plan they 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).
There are situations when the customer’s enrollment may be changed outside the annual enrollment period. Listed below are the reasons enrollment may be changed:
Situation/Status |
Description |
Auto Assignment |
When a customer has been auto assigned to a health plan, they may change health plans within 90 days. This is known as Freedom of Choice. |
Change to Full Services |
When a customer is eligible to move from FES to full services, the customer is sent a letter giving the opportunity to select a health plan and notifying them of the change in services. |
Continuity of Care |
Health plan changes may be approved on a case-by-case basis to ensure the customer's access to care. Approval requires an agreement from both health plan’s Medical Directors. The health plans determine the effective date of the enrollment change. NOTE When the health plans cannot reach an agreement, the AHCCCS Chief Medical Officer makes the decision and the Division of Health Care Management notifies the health plans and the customer. |
Family continuity |
A customer auto assigned to a different health plan than other currently enrolled family members can change to the health plan in which the other family members are enrolled. NOTE Other family members are not permitted to change to the health plan to which the customer was auto assigned. |
Foster Care |
When a child is no longer in the custody of Arizona foster care, the customer can choose a health plan. |
Grievance |
A change in enrollment is allowed when the change is a result of the final outcome of a grievance. |
Incorrect Enrollment |
If a customer made a pre-enrollment choice but was assigned to the wrong health plan in error, a change may be made. |
American Indians |
An American Indian customer may change from an available health plan to American Indian Health Program (AIHP) or from AIHP to an available health plan at any time. |
Newborn |
Newborns are automatically assigned to the mother’s health plan. The mother is given 90 days to select another health plan for the newborn. Newborns of Federal Emergency Services (FES) mothers are auto assigned and the mother is given 90 days to select a health plan. |
Same Day Plan Change |
A member can change their health plan choice within the same day of the original request. |
Customer Moves to a New GSA |
If the customer moves and his or her current health plan is not available in the new GSA, the customer has 90 days to choose a health plan in the new GSA. |
Customers can contact the Agency directly to report an enrollment error or request an enrollment change. The customer may:
· Call (602) 417-7100 or 1-800-962-6690; or
· Send written requests to 801 E. Jefferson St., MD 3400, Phoenix, AZ 85034.
Term |
Definition |
Enrollment Choice Month |
The first month after the material is mailed is the enrollment choice month. |
Transitional Month |
The second month is the transitional month. During this time AHCCCS notifies both the current health plan and the new health plan of the enrollment change. This allows the health plans adequate time to transfer records and welcome new members. |
Program |
Legal Authorities |
All Programs |
AAC R9-22-1702 42 CFR 438.71 |