Benefits

With Neighborhood INTEGRITY, you get all the benefits you are receiving from Medicare, Medicare Part D and Rhode Island Medicaid through one plan. Certain Medicaid benefits will still be covered through Rhode Island Medicaid, such as your dental and transportation services. We can help you access those services.

For a full list of benefits, please see your Member Handbook on the Member Materials pagefor a complete listing of covered services, exclusions, and prior authorization rules.

2019 Benefits

Medical Benefits  Member Copay
  Hospitalization – medical and behavioral health*  $0
  Skilled Nursing Facility  – 3 day hospitalization stay not required*    $0
  Emergency Care in the US  $0
  Provider’s Visits  $0
  Annual Physical  $0
  Urgent Care  $0
  MRI, CT Scans, Labs**  $0
  Durable Medical Equipment**  $0
  Outpatient Behavioral Health Services  $0
  Medicare Part B Drugs*  $0
  Preventive Services  $0
  Adult Day Health Programs**  $0
  Respite Services  $0
  Homemaker*  $0
  Physical Therapy Evaluation & Services**  $0
  Environmental Modification, e.g. shower chair*  $0
  Personal Emergency Response System  $0
  Part D and Over the Counter Drugs (Retail & Mail Order) $0

*Prior authorization rules apply
**Prior authorization rules may apply

Transportation will be provided through Medical Transportation Management, Inc.

Behavioral Health and Substance Use Treatment Services

Neighborhood INTEGRITY benefits include behavioral health and substance use services. Covered benefits have a $0 copay, coinsurance or deductible.

These services are managed by our partner Optum®. Our shared goal is to assist you in being as healthy as you can be, both mentally and physically. We cover both inpatient* and outpatient mental health and substance abuse programs designed to help diagnose and treat your condition.

Services include:

  • Day treatment
  • Intensive outpatient services
  • Substance abuse residential treatment
  • Methadone maintenance
  • Integrated health homes (IHH)
  • Mental health psychiatric rehabilitation residence (MHPRR)
  • Assertive community treatment (ACT)
  • Psychiatric rehabilitation day programs
  • Opioid Treatment Program (OTP)
  • Partial Hospitalization*

Please contact Optum® directly at 1-401-443-5995 (TDD/TTY 711) for more information on these services.

*Prior authorization rules apply

Long-Term Services and Supports (LTSS)

If eligible for Long-Term Services and Supports***, Neighborhood INTEGRITY provides coverage for:

  • Skilled nursing services**
  • Meals on Wheels
  • Assisted Living Facility*
  • RIte@Home shared living
  • Nursing Home Care*

You may also be interested in the Personal Choice program. This program allows you to be your own boss in hiring personal care assistants* and paying for the services that will help you to stay at home or in the community.

*Prior authorization rules apply
**Prior authorization rules may apply

Please refer to Member Handbook for a complete listing of services.

***Note: Members receiving Long Term Services and Supports (LTSS) may have a patient share responsibility. Please contact the Department of Human Services (DHS) Long Term Care Office (LTC) for more information on whether patient share applies to you.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.

Questions?

Please call us at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Neighborhood Health Plan of Rhode Island is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

ATENCIÓN: Si usted habla Español, servicios de asistencia con el idioma, de forma gratuita, están disponibles para usted. Llame a Servicios a los Miembros al 1-844-812-6896 (TTY 711), de 8 am a 8 pm, de lunes a viernes, de 8 am a 12 pm los Sábados. En las tardes de los Sábados, domingos y feriados, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día hábil. La llamada es gratuita.

ATENÇÃO: Se você fala Português, o idioma, os serviços de assistência gratuita, estão disponíveis para você. Os serviços de chamada em 1-844-812-6896 TTY (711), 8 am a 8 pm, de segunda a sexta-feira; 8 am a 12 pm no sábado. Nas tardes de sábado, domingos e feriados, você pode ser convidado a deixar uma mensagem. A sua chamada será devolvido no próximo dia útil. A ligação é gratuita.

Our plan can also give you materials in Spanish and Portuguese and in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.

Last Updated January 4, 2019, 5:56 pm

H9576_WebBenefits19 Approved 12/6/2018