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About Your Managed Long-Term Supports and Services (MLTSS) Plan
MLTSS provides health care that helps you do things you are no longer able to do for yourself. As part of this plan, you get access to:
- MLTSS providers
- Virtual care
- Behavioral health care
- Transportation to and from doctor visits
- Support from a Care Coordinator to help you reach your health care goals
- Care given in your home or in a supportive living facility
There are no copays for covered MLTSS services.
¿Qué incluye su cobertura?
Your MLTSS plan covers:
| Covered Service (Servicio incluido) | Detalles | Requires Prior Authorization? |
|---|---|---|
| Atención médica de emergencia | In an emergency, you can:
You don't need a referral or approval. Please call us within 24 hours of emergency care. |
No |
| Nursing Care | The care focus is on members' long-term needs rather than short-term acute care. Members with one of these waivers may qualify:
|
Depends on the service |
| Nursing Facility (NF) Services | A NF is a licensed facility that gives:
|
Sí |
| Physical Therapy, Occupational Therapy, Speech Pathology | Members with waivers to get care for Disabilities, HIV/AIDS and TBI may qualify. This requires a doctor's order. | Sí |
| Behavioral Health Services (BH) | BH services can help those facing mental health conditions. El tipo de servicio que necesita depende de su situación personal. Types of BH care include:
Some care may require prior authorization. No necesita ningún referido para consultar a un prestador de servicios médicos que forme parte de nuestra red. |
Depends on the service |
| Pathways to Success | This program is for Medicaid members under the age of 21. It offers some home and community-based services. The child must have major mental health needs to qualify. This can mean either a Serious Emotional Disturbance or Serious Mental Illness. Learn more about Pathways to Success. | No |
El Departamento de Cuidados de Salud y Servicios de Familia (HFS, en inglés) de Illinois tiene varios servicios exentos para quienes califiquen. BCCHP supports these waivers. You can get services to help you stay in your own home or live in a community setting. Find out more about Home and Community-Based Waiver Services.
¿Qué no incluye la cobertura?
This MLTSS plan does not cover:
- Medical benefits (For medical coverage, please contact your Medicare or Medicaid plan.)
- Prescription drugs (For prescription coverage, please contact your Medicare Part-D plan.)
- Emergency room visits (These are covered through Medicare, not MLTSS.)
- Dental or vision services.
- Services obtained outside the United States. For services outside of Illinois, a prior authorization will be needed.
This is not a full list of services not covered.
Want to know more about what your plan covers? Compruebe su Manual para asegurados de MLTSS . También puede llamar a Atención al Asegurado al 1-877-860-2837.
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