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Best Available Evidence (BAE)
The Centers for Medicare & Medicaid Services (CMS) makes it easy to get the latest information about Best Available Practice (BAE) policy. These policies address cost-sharing for low-income beneficiaries. To learn more, click here.
Potential for Contract Termination Notice
Simply Healthcare is required to notify beneficiaries that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice.
For information on Out-of-Network Coverage, Click Here.
Fraud Awareness Inserts/Flyers
- Identity Theft Prevention Tips - English, Spanish
- Protecting Medicare for Future Generations - English, Spanish
To report suspected fraud, waste or abuse, call our Confidential Compliance and Fraud, Waste & Abuse Hotline at 1-866-847-8247 or send us an email at firstname.lastname@example.org or fill out and submit the FWA form linked here (You may remain anonymous): https://www.simplyfwa.com/
Obtaining Care during a Disaster
In the event of a declared State of emergency, major disaster declaration or an announcement of a public health emergency by the Secretary of Health and Human Services, your plan will make the following exceptions to assure adequate care during the emergency:
- Approve services to be furnished at specified non-contracted facilities which are considered Medicare-certified facilities;
- Temporarily reduce cost sharing for plan-approved out-of-network services to the in-network cost-sharing amounts; and
- Waive in full the requirements for a primary physician referral where applicable.
Typically, the source whom declared the disaster or emergency will clarify when the disaster or emergency is over. If, however, the disaster or emergency time frame has not been closed within 30 days from the initial declaration, and, if CMS has not indicated an end to the disaster or emergency, your plan will resume normal operations 30 days from the initial declaration.
It's important we treat you fairly
That's why we follow Federal civil rights laws in our health programs and activities. We don't discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn't English, we offer free language assistance services through interpreters and other written languages. Interested in these services? Call Member Services for help (TTY: 711). Please see below Non-discrimination notice for more information.