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Hometown Health Plan ( HMO ) Member Rights and Responsibilities ____________________________________________________
Hometown Health Plan defines a member as an individual who meets all applicable eligibility requirements as defined in the Evidence of Coverage and whose enrollment form has been accepted by Hometown Health Plan in accordance with those requirements .
Members must choose a PCP at the time of enrollment or Hometown Health will choose one for the member based on geographic location . There is no coverage for PCP services outside of the network .
Requirements for members
Hometown Health Plan requires that the member fulfill these responsibilities when seeking services from preferred providers :
• Contact his or her PCP to make an appointment when services are needed
• We recommend that members establish themselves with the physician by scheduling an initial checkup , to meet the provider and fill out applicable paperwork
• Arrive for appointments with the provider on-time
• Notify the provider that he or she is insured through Hometown Health Plan
While some members may not know the name of their insurer , the provider staff should always ask for that information and review the identification card . When in doubt , please review eligibility on Link or contact Customer Service at 775-982- 3232 or 800-336-0123 .
• Pay all applicable co-payments , deductible or coinsurance for services rendered
• Upon referral , ensure that the PCP has referred the member to a network provider contracted with Hometown Health Plan