Policy statements
Protecting your health information
Health equity statement Prevea360 Health Plan is committed to health equity, which holds that no person be disadvantaged from achieving their potential as a result of barriers. We consider the many characteristics that make people unique — such as race, ethnicity, gender, sexual orientation, abilities, age, socioeconomic status, or veteran status — because any of these differences may be the basis for disparities in health care access, experience and outcomes. The workgroup is made up of people from across, and at all levels, of the company. The principles and commitments that guide our health equity work align with four areas of focus: • Leadership and decision-making: We will seek diversity in our representation and engagement to guide our work and decision-making at all levels of Medica, including our workgroup and leadership activities, and in our decision-making, policy and program development. • Data practices: We will expand our data collection efforts, where appropriate, to guide necessary health equity interventions and evaluate our health disparities reduction efforts. • Policies and procedures: We will examine our policies using an equity lens and make policy changes needed to promote equity, reduce health disparities, and eliminate barriers or unintended impacts on historically underrepresented and/or marginalized groups. • Access and outcomes: We will review and develop policies and care models that improve access to care and community resources that meet our members’ diverse health-related social needs and preferences.
Privacy and confidentiality statement Prevea360 Health Plan is required by law to maintain the privacy of your personal health and financial information (collectively referred to as “nonpublic personal information”) and provide you with written notification of our legal duties and privacy practices concerning that information. Please visit Prevea360.com/Privacy or call 1 (877) 230-7555 (TTY: 711 ) to request a copy. Prior authorization There are certain medical services or provider visits that must be authorized by Prevea360 Health Plan before we can provide a claims payment. A good rule to remember is that any time you seek services with an out-of-network provider, you will need to get prior authorization.* We require these authorizations so our Medical Affairs team can make sure you are getting the appropriate care. Visit Prevea360.com/ PriorAuthorization to learn more. General limitations and exclusions All benefits are subject to limitations and exclusions as described in your Schedule of Benefits and in your member certificate. The following list is not exhaustive and may vary based on your policy. For a complete listing refer to your member certificate.
* HMO members will need to get prior authorization any time they seek services with an out-of-network provider. PPO and POS members only: If prior authorization or pre-certification is not obtained when required, a penalty may be applied if your service is determined medically necessary. If your service is determined to have been not medically necessary, your claim may be denied.
Visit Prevea360.com or call 1 (877) 230-7555 (TTY: 711 ) | 19
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