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GET TO KNOW YOUR PARAMOUNT ADVANTAGE HEALTH INSURANCE

PARAMOUNT ADVANTAGEMEMBER GUIDE

PARAMOUNT ADVANTAGE MEMBER GUIDE | 1

No. 1 in women’s healthbased on the Ohio Department of Medicaid 2019 Report Card.

WELCOME NEW MEMBER,

At Paramount Advantage Medicaid, we look forward to getting to know you. As your managed health plan, we want to do all that we can to help you improve your health and well-being. You can count on us to be by your side every step of the way.

Your first step: Understand all of the benefits that come along with being a member of Paramount Advantage. Start by reviewing this member guide. You’ll learn about the great care and customer service you can access now that you’re a member, such as:

• Medical, prescription, dental and vision coverage – all with no copays

• Large network of doctors, drug stores and hospitals

• Free rides to medical appointments

• Nurse advice hotline available 24 hours a day, seven days a week

• Reward cards for pregnant women who attend prenatal and postnatal doctor visits

• Rewards for the whole family for staying healthy through Paramount’s partnerships with the Cleveland Browns and Cincinnati Bengals.

Your second step: Complete your health risk assessment. Paper or online – it will only take 10 minutes to fill out. And, you’ll find out what health problems you may be at risk for. (learn more on page 12)

Your third step: Keep your appointments with your county Department of Job and Family Services. That includes providing them with any information they request. If you don’t, you could lose your Medicaid coverage. Then, Paramount would no longer be able to provide your health insurance. We don’t want that to happen.

Again, we look forward to joining your journey to good health. We’d love to hear how it’s going. To share your thoughts and ask questions, please see our contact information on the back cover of this member guide.

Cheers to your good health,

Lori Johnston President Paramount Insurance

Dale Ocheske Administrative Director Paramount Insurance


TABLE OF CONTENTS

TOOLS AND RESOURCES

Member ID Card 6

Member Handbook 6

Your PCP 6

Finding a Doctor 7

Finding a Pharmacy 7

Finding a DME Supplier 7

Know Where To Go 8

Member Services 10

Online Resources 12

Community Resources 13

BENEFITS

Medical 15

Prescriptions 15

Dental 15

Vision 16

Healthchek 16

24-Hour Nurse Line 17

Condition and Disease Management 17

ADDITIONAL SERVICES

Transportation Assistance 19

Prenatal to Cradle 21

Cradle to Crib 23

Honoring our Veterans 25

Family Advisory Council 25

SPECIAL PROGRAMS

Healthy Rewards Program 27

NOTICE OF PRIVACY PRACTICES 28

NOTICE OF NONDISCRIMINATION AND ACCESSIBILITY 31

CONTACT US 32

4 | PARAMOUNT ADVANTAGE MEMBER GUIDE

TOOLS AND RESOURCES

MEMBER ID CARD

You and your family should have received a Paramount Advantage Member ID card. Please carry your Member ID card with you at all times. Show it when you visit:

• Doctor’s office

• Pharmacy

• Eye doctor

• Dentist

• Urgent care or emergency department

Need a new ID card? We’d be happy to send one. Please call Member Services at 800-462-3589 (TTY 888-740-5670) if:

• The PCP (primary care provider) on your card is not right

• You need to change your PCP

• You lost your ID card and need a new one

• Your card is worn and hard to read

You can also order, download or print a new ID card through myparamount.org.

MEMBER HANDBOOK

The Paramount Advantage member handbook answers many questions. It also explains your benefits and services in detail. In fact, you may even learn about some benefits you didn’t know you have!

Keep your member handbook in a safe place. If you need a new copy:

• View it online at paramounthealthcare.com/medicaid

• Call Member Services at 800-462-3589 (TTY 888-740-5670). We will mail you a new one.

YOUR PRIMARY CARE PROVIDER (PCP)

As a Paramount Advantage member, you’re required to have a primary care provider (PCP). Your PCP is listed on your Paramount Advantage Member ID card. Your PCP is your main medical contact. They will help you manage all aspects of your health care. Contact your PCP for:

• Annual well visits

• Sick visits

• Questions about your health

• Blood work

• Recommendations for a specialist

• Follow-up care if you’ve been to the hospital


Find a Doctor

You must use providers who are covered by Paramount Advantage. To find one, use our provider directory. It lists all of our doctors and other types of providers. To access the provider directory:

• Visit myparamount.org/provider-search (Select “Paramount Advantage” as the Product Type)

• Call Member Services at 800-462-3589 (TTY 888-740-5670)

• Use Live Chat at paramounthealthcare.com/memberlivechat

Find a Pharmacy

Most pharmacies accept Paramount Advantage insurance. But, make sure your pharmacy is in the Paramount Advantage network. Find out by:

VISITING OUR WEBSITE paramounthealthcare.com/medicaid

CALLING MEMBER SERVICES 800-462-3589 (TTY 888-740-5670)

USING LIVE CHAT paramounthealthcare.com/memberlivechat

Remember, we cover large pharmacies such as WalMart, Target, Kroger, Rite Aid and many more.

Find a DME Supplier

Some items, such as diabetic testing supplies, breast pumps and blood pressure cuffs, need to be ordered through a durable medical equipment (DME) supplier. Many DME suppliers will mail your supplies directly to your home. Be sure to ask!

Visit myparamount.org/provider-search

• For “Product Type,” select “Paramount Advantage”

• For “Provider Type,” select “Ancillary” and then “Durable Medical Equipment”


KNOW WHERE TO GONot sure where to go? Call our 24-Hour Nurse Line at 800-234-8773 to help you decide. Or use our examples here.

Doctor’s Office A doctor’s visit is best for routine and non-emergency services such as:

• Diabetes management

• Physicals and annual exams

• Wellness services

• Specialty referrals

• Immunizations

• Allergy management

• Asthma

• Pregnancy testing

• Non-emergency pediatric, adult, internal medicine or geriatric care

• Prescription and drug management

• Chronic conditions

Your primary care physician (PCP) is your key to care. In addition to sick visits, they help manage your everyday health, monitor and treat ongoing conditions, and refer you to specialists when you need them.

Urgent Care

When your provider is not available and you need medical attention right away, consider an urgent care. They treat patients for minor, non-life threatening medical emergencies, or problems that could become worse if you wait:

• Minor injuries – sprains or strains

• Cuts or lacerations, when stitches may be needed

• Bladder infections

• Atypical headache

• Acute pain

• Fever that spikes

• Abdominal pain

• Asthma attack

• Minor burns

• Lab testing

• X-ray

Emergency Department

Emergency departments treat life threatening emergencies, including:

• Chest pain

• Severe shortness of breath

• Head injuries or trauma injuries

• Pregnancy complications

• Seizures

• Severe pain, shock

• Serious mental health conditions

• Uncontrollable bleeding

• Broken bones

• Poisoning

• Amputation

• Severe burns, electrical shock or cuts

Do not hesitate to call 911 or head to the nearest emergency department if you’re experiencing a life-threatening injury or condition like uncontrollable bleeding, pregnancy complications, or serious mental health conditions.


Phone Number Toll-free: 800-462-3589

TTY: 888-740-5670

Live Chat paramounthealthcare.com/memberlivechat

Available 9 a.m. – 4 p.m.

Email [email protected]

Hours Monday – Friday, 7 a.m. – 7 p.m.

Holidays We are closed on the holidays below. When a holiday falls on a Saturday, we’ll be closed the Friday before. When the holiday falls on a Sunday, we’ll be closed the Monday after.

• New Year’s Day

• Memorial Day

• Independence Day

• Labor Day

• Thanksgiving Day

• The day after Thanksgiving Day

• Christmas Day

MEMBER SERVICES Our Member Services team is ready to help when you need them! They can answer your questions and help you with complaints, benefits and services.

Keep in touch! If your phone number or address changes, please let us know. Also, be sure to let your Job and Family Services case worker know.


As a Paramount Advantage member, you can have a personal contact in our call center. This means, each time you call us, you will talk to the same person – and you’ll even have their personal phone number. You’ll get to know your contact and they’ll get to know you!

Call Center Quick Facts

NUMBER OF MEMBER SERVICES REPS:

25AVERAGE NUMBER OF CALLS EACH DAY:

650AVERAGE LENGTH OF CALL:

4 m30sTYPICAL WAIT TIME:

under30seconds

Ask for a Personal Call Center Representative!

LOCATED IN: TOLEDO, OHIO

We understand how frustrating it can be when you don’t understand your health coverage. Or, maybe you have questions about your benefits. As a Paramount member, you can have your very own personal call center representative. This means you will speak to the same person in Member Services every time you call. You’ll enjoy the personalized experience of hearing a familiar voice.

You have two ways to sign up:

1. Complete our online form here: https://www.paramounthealthcare.com/services/members/personal-call-center-representative-form

OR

2. Call Member Services at 800-462-3589


Take your Health Risk Assessment (HRA)

Log in to myparamount.org to take this quick 10-minute quiz to see what health problems you may be at risk for. The HRA will ask you questions about:

• Current medical issues

• Types of food you eat

• Stress levels

• Work habits

• And more

At the end of the quiz, you’ll receive a nice summary of your current health status. Review it with your PCP at your annual well visit.

A paper form is included with your new member packet. Additional paper forms can be requested from Member Services.

ONLINE RESOURCES

paramounthealthcare.com/medicaid Use our website to find information about programs and benefits. Access it any time – day or night – from your computer, smart phone or tablet. Bookmark paramounthealthcare.com/medicaid. Then, you’ll always be able to find us!

myparamount.org MyParamount.org is your personal portal for your Paramount Advantage benefits. Register and log in to find:

• Benefit information

• Digital ID card

• Electronic member handbook

• Claims history

• Recent provider phone numbers

• Also, connect your family under one single login.

Facebook Find us on Facebook at Paramount Health Care for:

• Health tips

• Health news

• Local community events near you


COMMUNITY RESOURCES

If you’re looking for resources, your community has them available. They can help with things, such as:

• Child care

• Food

• Housing

• Utilities

• Pregnancy

• Crisis services

To find services near you, visit https://www.paramounthealthcare.com/medicaid/tools-and-resources/community-resources.

United Way 211 Benefits.Ohio.gov

United Way is always available to help. Reach United Way by:

Here, Ohio residents can find help with:

• Food and cash

• Women, infants and children food assistance (WIC)

• Special needs help

• Ohio Means Jobs

• Child care

• Unemployment

• Housing help

• Public utilities help

• Mental health and addiction services

211 www.211.org


PARAMOUNT ADVANTAGE

BENEFITS

PARAMOUNT ADVANTAGE

BENEFITSMEDICAL

Paramount Advantage covers your medical appointments and services when you use one of our in-network doctors or facilities. Make sure your doctor is part of our network.

We cover services, such as:

• Appointments with doctors, including specialists

• Blood work and X-rays

• In-patient and out-patient hospital stays

• Surgery

• Urgent care and emergency services

• Ambulance rides

Some services require a prior authorization (all insurance plans require prior authorizations). This means that the service needs to be approved before it’s performed. Your doctor will help submit the prior authorization request to us.

Remember, this is not a complete list of all services covered. Please refer to your member handbook for more information.

PRESCRIPTION

We cover all medically necessary, Medicaid-covered prescription drugs. Make sure to use an in-network pharmacy when getting prescriptions.

We pay for covered prescriptions at no cost to you. We even cover some over-the-counter products, too.

OVER-THE-COUNTER (OTC) MEDICATION

Paramount Advantage covers some OTC (over-the-counter) medications at no cost to you. Ask your doctor to write a valid prescription. Then, take it to your closest in-network pharmacy.

Some covered OTC medications include:

• Pain medicines: Ibuprofen, aspirin, acetaminophen and naproxen

• Stomach/intestine/laxatives: Antacids, fiber supplements, stool softener

• First aid: Bacitracin, Neosporin

• Allergy medicine: Allegra, Benadryl, Zyrtec

• Cough and cold: Mucinex, Robitussin, saline nasal spray

• Vitamins: Calcium, iron, multivitamins, prenatal vitamins

Generic medications will be used when available.

For a full list of covered OTC medications, visit: paramounthealthcare.com/medicaid/health-benefits/ Or, call Member Services at 800-462-3589 (TTY: 888-740-5670).

DENTAL

A healthy mouth is important to your well-being. Paramount Advantage includes the following dental care services:

• Routine oral exams (Every six months for members under 21 years old. Once a year for members 21 years and older.)

• X-rays

• Fillings

• Simple extraction/restorations

Also, the services below are covered. But, we need to approve the service before you get it. This approval is called prior authorization.

• Full and partial dentures

• Orthodontia

• General anesthesia

• Surgical extraction

• Comprehensive restorations such as root canals, post and core and crowns

You must use a participating dentist. Find a dentist near you by:

• Visiting myparamount.org/provider-search

• Calling Member Services at 800-462-3589 (TTY: 888-740-5670)


VISION

Vision care is important to your health. That’s why eye care is covered.

Age Benefit

Under 21 yearsOne vision exam every 12 months

One pair of frames and lenses every 12 months (more frequently if medically necessary)

You must use a participating vision provider. To find a provider near you:

Visit myparamount.org/provider-search

Call Member Services at 800-462-3589 (TTY: 888-740-5670)

21 – 59 yearsOne vision exam every 24 months

One pair of frames and lenses every 24 months

60+ yearsOne vision exam every 12 months

One pair of frames and lenses every 12 months

HEALTHCHEK

For everyone eligible for Medicaid, and younger than 21, Healthchek covers:

• Medical exams

• Immunizations (shots)

• Health education

• Lab tests

These exams make sure that children are healthy. They also check how children are growing physically and mentally.

When do children need exams?

Mothers should have prenatal exams.

Children should have exams at birth, 3 – 5 days old and at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months old.

Once 3 years old, children should have at least one exam per year.

Healthchek services are available at no cost to members. They include:

• Preventive check-ups for newborns, infants, children, teens, and young adults under the age of 21

• Complete medical exams (They include a review of physical and mental health growth.)

• Vision exams

• Dental exams

• Hearing exams

• Nutrition checks

• Developmental exams

• Lead testing

• Lab tests for certain ages

• Immunizations (shots)

• Medically necessary follow-up care to treat physical, mental or other health problems or issues found during a screening. This could include, but is not limited to, services such as:

• Visits with a primary care provider, specialist, dentist, optometrist, and others to diagnose and treat problems or issues

• Inpatient or outpatient hospital care

• Clinic visits

• Prescription drugs

• Lab tests

• Health education


CONDITION AND DISEASE MANAGEMENT

Sometimes taking care of a health condition can be overwhelming. Let our condition management team help you! Our specialists are experts in taking care of chronic (ongoing) conditions. They can help you manage:

• Asthma

• Chronic kidney disease (CKD)

• Chronic heart failure (CHF)

• Chronic obstructive pulmonary disease (COPD)

• Depression

• Diabetes

• Migraine headaches

• Post-cardiac events

• Reproductive health issues

• Osteoporosis fractures

All identified members receive some type of support. Those at greatest risk receive more hands-on help. But, everyone receives information in the mail to remind you of important tests and appointments you should have.

CARE MANAGEMENT

If your health condition requires more support from professionals, our care management team can help! Care managers help you access care through Paramount Advantage providers and connect you with community resources. Also, they teach you ways to play a bigger role in your own health care. They work with you over the phone and in person to identify your needs.

If you’ve been hospitalized, you may hear from one of our care managers. We want to make sure you have everything you need when you leave the hospital, such as:

• New medications

• Equipment

• Home care

24-HOUR NURSE LINE

Have a medical question? Call one of our nurses at the 24-Hour Nurse Line any time of day or night. Nurses answer general medical questions about:

• Where to go for care

• Medication questions

• How to treat minor illnesses at home

800-234-8773AVAILABLE 365, 24/7


ADDITIONAL SERVICES

ADDITIONAL SERVICES

TRANSPORTATION ASSISTANCE

Need a ride? We can help with transportation for your medical appointments and more.

What appointments are eligible?

• Medical, dental, vision, therapy, mental health, and addiction appointments

• Health and disease education

• Pharmacy (stand-alone or added during trip scheduling)

• Prenatal and postpartum appointments, and prenatal education

• WIC and food clinics

• Emergency food banks (call Member Services to set up)

• Medicaid redetermination, BCMH, waiver and SSI appointments

What travel options do I have?

• Vehicle transportation: Cab, van, Lyft or wheelchair-accessible ambulette, share-a-ride, non-medical assisted service.

• Public transit: We will mail you a bus pass (Akron, Canton, Cincinnati, Cleveland, Columbus, Dayton, Mansfield, Toledo and Youngstown). Ask how to get a monthly pass.

• Mileage reimbursement: Drive to your appointment (or have someone drive you). We will use a set rate for mileage to repay you. You will receive a check. It may take up to 30 days. We can’t backdate mileage reimbursement.

How many rides am I allowed?

Each Paramount Advantage member is eligible for: 30 one-way trips or 15 round trips each year (Jan. 1 – Dec. 31).

How do I schedule a ride?

Schedule all transportation up to 30 days in advance, but no less than 2 full business days (48 hours) in advance. If riding with children, you must provide car seats and boosters per Ohio law.

Call 866-837-9817 (TTY call 800-750-0750) between 7 a.m. and 7 p.m., Monday to Friday, to:

• Schedule vehicle transportation

• Request a bus pass

• Request mileage reimbursement

Tip: Download the Access2Care app from your mobile device for trip scheduling, status, and cancellation.

866-837-9817TRANSPORTATION ASSISTANCE:


PRENATAL TO CRADLE

EARN $150 800-462-3589


PRENATAL TO CRADLE

We want you and your baby to get a healthy start! Sign up for Prenatal to Cradle and you can earn up to $150 in reward cards and enter a drawing for a four-week supply of diapers!

How do I earn reward cards?

1. Schedule and attend all your prenatal and postpartum (after-delivery) appointments.

2. Paramount Advantage will track your visits.• Go to 1 or more prenatal visits in your first

trimester. Earn one $50 reward card.• Go to 3 or more prenatal visits in your second

trimester. Earn one $25 reward card.• Go to 8 or more prenatal visits in your third

trimester. Earn one $25 reward card.• Go to 1 or more postpartum visits 7 – 84

days (2 – 12 weeks)* after delivery. Earn one $50 reward card.

3. Once your visit is applied to the Prenatal to Cradle program, we’ll mail your reward card to you. Make sure we have your correct address on file.

* Your provider may want to see you more than once after delivery. But only the 7 – 84 day visit counts for the $50 reward card.

How does it work?

1. Register• Go to paramounthealthcare.com/rewards• Or, call 800-462-3589

2. Paramount Advantage will send you a letter in the mail. It will confirm your registration. Also, it will include resource information.

3. Paramount Advantage will track how many prenatal and after delivery (postpartum) appointments you go to. You must be a Paramount Advantage member at the time of your prenatal or postpartum appointment(s) to qualify for reward cards. Reward cards are processed electronically based on claims from your medical provider’s office.

4. Reward cards will be mailed to your most recent address on file with Paramount Advantage. Make sure we have your correct address on file.

What about the diaper drawing?

The month that you register, you are automatically entered into a drawing to win a four-week supply of diapers.

800-462-3589PRENATAL TO CRADLE


EARN $100 800-462-3589

CRADLE TO CRIB:


CRADLE TO CRIB

Your baby’s early years are key to their lifelong health. Baby well visits, or regular checkups, help make sure your baby is growing and developing as they should. And, it gives you a chance to ask your doctor questions about your baby’s eating, sleeping and vaccinations.

Babies should have eight well visits before turning 15 months old. Your baby’s pediatrician will help you stay on track.

How do I earn the reward card?

1. Schedule and attend at least six well visits before your baby turns 15 months old.

How does it work?

1. Register your baby, any time from birth to 15 months: * Go to paramounthealthcare.com/rewards * Or, call 800-462-3589

2. Paramount Advantage will send you a letter in the mail. It will confirm your registration. Also, it will include resource information.

3. Paramount Advantage Medicaid will track your baby’s appointments and count them toward your $100 reward card. Any well visits attended prior to your registration will be counted towards your reward.

For a well visit to count toward the reward card program, your baby must be a Paramount Advantage Medicaid member at the time of the appointment.

Reward cards are processed electronically once a month. They are based on Medicaid claims from your doctor.

800-462-3589CRADLE TO CRIB


HONORING OUR VETERANS

We are honored to support the healthcare needs of our veterans. If you’re a veteran and have Paramount Advantage, let us connect you to services that are available in your community.

We can assist you with:

• MEDICAL CARE We work with our veterans to make sure they are receiving all necessary medical care.

• MONTHLY PENSION Veterans may receive a monthly tax-free pension for their disability received during service. Our team will assist in connecting you to the appropriate office for consideration.

• COMMUNITY RESOURCES Veterans may receive help with finances, housing, utilities and groceries. We can connect you to the right resources.

For more information on our Honoring Our Veterans program or to get connected with a specialist, call Member Services at 800-462-3589 (TTY: 888-740-5670).

FAMILY ADVISORY COUNCIL

A great way to provide us feedback on our services.

We welcome feedback and ideas to improve Paramount Advantage. One way we listen to our members is through our Family Advisory Council (FAC). Our FAC is a group of members – just like you. They meet a few times a year to talk about ways we can improve our plan.

Our members come from a wide range of backgrounds. This makes our FAC meetings diverse and strong in opinions and feedback. Each year, we host meetings in multiple Ohio cities at Federally Qualified Health Centers (FQHC). And, each year, we rotate the cities where we hold our meetings. in 2020, we’ll visit:

• Cleveland, Ohio

• Dayton, Ohio

Would you like to join the Paramount Advantage FAC? Call Member Services or email [email protected].


SPECIAL PROGRAMS


CLEVELAND BROWNS HEALTHY REWARDS

Register: paramounthealthcare.com/browns

If you live in the Cleveland Browns territory, you could win:

• Game tickets with Browns Bucks

• Field Day event

• Away-game trip with all expenses paid!

• VIP Training Camp experience

• Suite tickets

• Autographed merchandise

WHO DEY! HEALTHY REWARDS

Register: paramounthealthcare.com/bengals

If you live in the Cincinnati Bengals territory, you could win:

• Game tickets with Bengals Bucks

• Sideline pass

• VIP Training Camp experience

• On-Field event

• Autographed merchandise

HEALTHY REWARDS

We’ve partnered with NFL teams – the Cleveland Browns and the Cincinnati Bengals – to encourage annual wellness exams! It’s simple:

1. Schedule an appointment with your doctor for an annual well visit.

2. After your visit, register online for your chance to win prizes.

The earlier you enter, the more chances you have to win!


PARAMOUNT NOTICE OF PRIVACY PRACTICESI. THIS NOTICE DESCRIBES HOW YOUR NON- PUBLIC

PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE COLLECTED, USED AND DISCLOSED BY US, AND HOW YOU CAN GET ACCESS TO THE INFORMATION WE HAVE ABOUT YOU; PLEASE REVIEW IT CAREFULLY The terms of this Notice of Privacy Practices apply to the following affiliated covered entities: Paramount Health Care, Paramount Care of Michigan, Inc., Paramount Advantage and Paramount Insurance Company (collectively Paramount) operating as health plans to carry out payment and health care operations as permitted by law.

II. WE HAVE A LEGAL DUTY TO PROTECT YOUR HEALTH INFORMATION We are required by law to protect the privacy of your health information. This includes all non-public personal information about you, such as whether you are enrolled in a Paramount health benefits plan, your premium information and your claims information. We are prohibited by law from using or disclosing genetic information about you for underwriting purposes. We are required to provide you with this notice about our privacy practices. We are required to comply with all of the terms described in the current version of our Notice of Privacy Practices. You can request a copy of this notice from the contact office listed in Section X at any time and can view a copy of this notice on our website at: www.paramounthealthcare.com or www.paramountcareofmichigan.com.

III. HOW WE COLLECT INFORMATION We collect information about you that is related to your participation in a Paramount health benefits plan. We receive information from you on applications and other forms that you submit to us, and from your transactions with us, our affiliates in the ProMedica Health System or others.

IV. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

A. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION Paramount collects health information from you and stores it in a paper file and on computer. Except as outlined below, we will not use or give out information about you for any purpose unless you have signed an authorization form.

1. To carry out payment. When you enroll with Paramount, we may disclose information about you to carry out payment functions. For example, we may use information about you for the purpose of:• claims payment• collection of premiums• coordination of benefits• subrogation of health benefit claims

2. For regular health plan operations. When you enroll with Paramount, we may disclose information about you to operate this health plan. For example, we may use information about you for the purpose of:• referrals, pre-certification and case management• distribution of disease management educational

notices and preventive care reminders• quality assessment and improvement activities

• medical review and auditing functions including fraud and abuse detection

• underwriting and premium rating• customer service and requests for internal

reviews• accreditation activities and program licensure

Additionally, we give your information to our business associates, such as a pharmacy benefit manager and others, that process our claims. We may also provide information about you to our accountants, attorneys, consultants and others in order to make sure we are complying with the laws that affect us.

3. When required by federal, state or local law, judicial or administrative proceedings or law enforcement. For example, we give out your information when the law requires that we report information to government agencies and law enforcement personnel in response to a subpoena, when ordered by the court or in response to a discovery request.

4. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or audit to determine beneficiary eligibility and compliance with program standards.

5. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may give your information to law enforcement personnel or persons able to prevent or lessen such harm.

6. For specific government functions. We may give out information on military personnel and veterans in certain situations. We may give your information to correctional institutions and law enforcement in custodial situations. We may also give your information for national security or intelligence activities.

7. For workers’ compensation purposes. We may give out your information in order to comply with workers’ compensation laws.

8. To family and friends involved in your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with family, friends, or others who are involved in your care or in payment for your care.

9. For research purposes. We may give information about you in order to conduct research that has been approved by the ProMedica Institutional Review Board.

B. DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION Before we use or disclose your personal health information for any reason other than those reasons listed in Section IV.A, we will need to get your written authorization. We will need your written authorization


for the use and disclosure of psychotherapy notes, marketing, and the sale of protected health information. We may not sell your protected health information without your written authorization. If you authorize us to use or disclose your information, you can revoke your authorization by notifying the office listed in Section X in writing.

V. YOUR HEALTH INFORMATION RIGHTS

A. THE RIGHT TO REQUEST LIMITS ON HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION You have the right to ask that we limit how we use and give out your information. We will carefully consider your request, but are not required to accept it. If we accept your request, we will put it in writing and abide by it.

B. THE RIGHT TO CHOOSE HOW WE SEND YOUR INFORMATION TO YOU You have the right to ask that we send information to you at an alternate address. For example, you may ask us to send information to your work address rather than your home address. You can also ask that it be sent by alternate means. For example, you can ask that we send information by fax instead of regular mail. We will agree to your request if we can easily provide it in the format you request.

C. THE RIGHT TO SEE AND GET COPIES OF YOUR HEALTH INFORMATION Most of the time, you have the right to look at or get copies of your health information that we have. Your request must be on the appropriate form and signed by you or your legally authorized representative. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons why and explain how you can have the denial reviewed.

D. THE RIGHT TO GET A LIST OF WHO WE HAVE GIVEN YOUR INFORMATION TO You have the right to get a list of certain instances in which we have given out your health information after April 14, 2003.

E. THE RIGHT TO CORRECT OR UPDATE YOUR HEALTH INFORMATION If you believe that there is a mistake in your information or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. Your request and your reason for the request must be submitted on the appropriate form. Each request will be carefully considered. If we approve your request, we will make the change to your information, tell you that we have done it and tell others that need to know about the change.

F. HOW TO MAKE REQUESTS To make requests under Section V A through E, complete the appropriate form available from the contact office listed in Section X and send it to the address indicated.

G. THE RIGHT TO GET THIS NOTICE You have the right to get a copy of this notice by e-mail. You also have the right to request a paper copy of this notice.

H. THE RIGHT TO PRIVACY BREACH NOTIFICATION You have the right to be notified after a breach of unsecured protected health information has occurred.

VI. PROCEDURES TO MAINTAIN CONFIDENTIALITY AND SECURITY Paramount restricts access to health information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic and procedural safeguards that comply with applicable law.

VII. CHANGES TO THE POLICY If our privacy policy should change at any time in the future, we will promptly change, post and distribute the new notice. We will also distribute this Notice of Privacy Practices annually. We reserve the right to apply any changes to our privacy policy or this notice to all of the personal health information that we maintain, including information collected before the date of the change.

VIII. COMPLAINTS If you think that we may have violated your privacy rights or you disagree with a decision we made about your health information, you may file a complaint with the office listed in Section X. You also may send a written complaint to the Secretary of the Department of Health and Human Services in Washington, D.C. We will take no action against you if you file a complaint about our privacy practices.

IX. PROTECTIONS APPLY TO FORMER MEMBERS Paramount does not destroy information about you when you terminate your coverage with us. However, the policies and procedures outlined in this notice continue to apply to protect the information of former members.

X. OFFICE TO CONTACT FOR INFORMATION ABOUT THIS NOTICE If you have any questions about this notice or any complaints about our privacy practices, please contact:

Paramount Member Services Department 1901 Indian Wood Circle Maumee, OH 43537

Mailing Address: P.O. Box 928 Toledo, OH 43697-0928

419-887-2525 800-462-3589

XI. EFFECTIVE DATE OF THIS NOTICE This notice goes into effect on April 14, 2003. Revised Date: September 23,2013 To the extent state privacy laws apply, these state laws (rather than the terms of this notice) might impose the privacy standard under which Paramount is required to operate.


English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 800-462-3589 (TTY 888-740-5670).

Albanian: KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-800-462-3589 (TTY: 1-888-740-5670). Arabic: تتحدث اذكر اللغة، فإن خدمات المساعدة ملحوظة: إذا كنت

)رقم هاتف 9853-264-008-1اللغوية تتوافر لك بالمجان. اتصل برقم (.0765-047-888-1الصم والبكم:

Bantu: ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-800-462-3589 (TTY: 1-888-740-5670). Bengali: লক্ষ্য করুনঃ যদি আপদন বাাংলা, কথা বলতে পাতেন, োহতল দনঃখেচায় ভাষা সহায়ো পদেতষবা উপলব্ধ আতে। ফ ান করুন ১-800-462-3589 (TTY: ১-888-740-5670)। Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-462-3589 (TTY：1-888-740-5670）。 Cushite: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-462-3589 (TTY: 1-888-740-5670). Dutch: AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel 1-800-462-3589 (TTY: 1-888-740-5670). French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-462-3589 (ATS : 1-888-740-5670). German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-462-3589 (TTY: 1-888-740-5670). Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-800-462-3589 (TTY: 1-888-740-5670). Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-462-3589 （TTY:1-888-740-5670）まで、お電話にてご連絡ください。 Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-462-3589 (TTY: 1-888-740-5670) 번으로 전화해 주십시오.

Nepali: ध्मान दिनहुोस:् तऩार्इलं ेनेऩाली फोल्नहुुन्छ बने तऩार्इकंो ननम्तत बाषा सहामता सेवाहरू ननिःशलु्क रूऩभा उऩलब्ध छ । पोन गनुहुोस ्1-800-462-3589 (दिदिवार्इ: 1-888-740-5670) । Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-800-462-3589 (TTY: 1-888-740-5670). Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-462-3589 (TTY: 1-888-740-5670). Romanian: ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-800-462-3589 (TTY: 1-888-740-5670). Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-462-3589 (телетайп: 1-888-740-5670). Serbo-Croatian: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-800-462-3589 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-888-740-5670). Somali: DIGTOONI: Haddii aad ku hadasho Af Soomaali, adeegyada caawimada luqadda, oo lacag la’aan ah, ayaa laguu heli karaa adiga. Wac 1-800-462-3589 (TTY: 1-888-740-5670). Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-462-3589 (TTY: 1-888-740-5670). Syriac: ܚܬܘܲܢ ܐܸܢ: ܙܼܘܵܗܵܪܐ ܡܸܙܡܼܝܬܘܲܢ ܹܟܐ ܼܐܲ ، ܵܐܬܲܘܵܪܵܝܐ ܸܠܵܫܵܢܐ ܼܗܲ

ܒܠܼܝܬܘܲܢ ܵܡܨܼܝܬܘܲܢ ܹܬܐ ܕܼܩܲ ܪܵܬܐ ܸܚܠܼܢܲ ܼܝܲ ܵܓܵܢܐܼܝܬ ܒܸܠܵܫܵܢܐ ܕܼܗܲ ܠ ܩܪܘܲܢ. ܼܡܲ ܼܥܲ (TTY: 1-888-740-5670) 3589-462-800-1 ܐܸܡܢܵܝܢܵܵ

Ukrainian: УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-462-3589 (телетайп: 1-888-740-5670). Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-462-3589 (TTY: 1-888-740-5670).


NOTICE OF NONDISCRIMINATION AND ACCESSIBILITY: DISCRIMINATION IS AGAINST THE LAW

Paramount Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Paramount Advantage does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Paramount Advantage provides:

• Free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters

• Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Free language services to people whose primary language is not English, such as:

• Qualified interpreters

• Information written in other languages

If you need these services, contact Member Services at 800-462-3589.

If you believe that Paramount Advantage has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance. You can file a grievance in person or by mail, fax, or email.

Member Services 1901 Indian Wood Circle Maumee, Ohio 43537

Phone: 419-887-2525 Toll Free: 800-462-3589 TTY: 888-740-5670 Fax: 419-887-2047

Email: [email protected]

If you need help filing a grievance, Member Services is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Ave. SW Room 509F, HHH Building Washington, DC 20201

800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.


Member Services Get answers to questions about benefits, prescription coverage, transportation and more!

CALL TOLL FREE: 800-462-3589 (TTY: 888-740-5670)

EMAIL: [email protected]

Live Chat paramounthealthcare.com/memberlivechat

Transportation Scheduling 866-837-9817

Prenatal to Cradle 800-462-3589

Cradle to Crib 800-462-3589

Member Portal myparamount.org

TIP: Use the portal to update your phone number and mailing address.

Website paramounthealthcare.com/medicaid

© 2020 Paramount Advantage

paramounthealthcare.com/medicaid

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