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HMO Member Handbook

Welcome to Dean Health Plan. This is your complete member guide that explains your coverage with Dean Health Plan. If you have additional questions, please visit our frequently asked questions page or call one of our friendly Customer Care Specialists at (800) 279-1301.

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Enrollment & Eligibility

In this section of the Member Handbook you will find information detailing

  • Dependent Eligibility
  • Special Enrollment Periods
  • Your ID Card
  • Canceling Your Coverage
  • Address Changes

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Your Primary Care Practitioner

In this section of the Member Handbook you will find information detailing

  • Primary Care Practitioner
  • Changing Your Primary Care Practitioner
  • Provider Recredentialing
  • Advance Directives

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Prior Authorization Process

In this section of the Member Handbook you will find information detailing:

  • Understanding the Prior Authorization Process
  • Out-of-Area Urgent or Emergency Visits and Follow-ups
  • Getting the Right Care: Primary, Urgent, or Emergency
  • Dean On Call, Our 24-Hour Nurse Line

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Understanding Your Benefits

• Your Member Benefits • Privacy and Confidentiality
• Member Rights and Responsibilities • Quality Improvement Program
• Co-payments, Deductibles and Co-Insurance • Subrogation
• How Claims are Processed • Case Management
• Mental Health and Alcohol and Other Drug Abuse Services • Services Obtained Outside the System or Service Area
• Prescription Drug Benefit • New Technology
• Drug Formulary • Complaints, Appeals and Grievances
• Insulin and Disposable Diabetic Supplies • Utilization Management
• Obtaining Durable Medical Equipment and Supplies • How to Obtain Specialty Care
• Coordination of Benefits • Hospital Services

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Privacy

In this section of the Member Handbook you will find information detailing

  • Web Privacy Statement
  • Patient Privacy Statement
  • Notice of Privacy Practice

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