- What happens if I do not choose a Health Plan?
- What are my Health Plan choices?
- Which Health Plan is best for me?
- How do I find out which Health Plan my doctor works with?
- How do I sign up for the Health Plan I want?
- How do I use NH EASY to sign up for a Health Plan?
- How do I get a NH EASY account?
- What happens after I pick Health Plan?
- Can I change Health Plans if I do not like the one I'm in?
- What can I do if I have a complaint or disagree with a decision?
If you do not act by the due date that is on your letter, a Health Plan will be chosen for you.
If MCM is "voluntary" for you and you do not pick a Health Plan or tell us that you do not want to pick a Health Plan by the due date, one will be chosen for you.
If MCM is "mandatory" for you, a Health Plan will be chosen for you.
You will be told in a letter which Health Plan has been "auto-assigned" to you.
You can pick from these two Health Plans:
|Health Plan Name||Health Plan Contact Information|
|New Hampshire Healthy Families||www.Nhhealthyfamilies.com
Member Services: 1-866-769-3085
|Well Sense Health Plan||www.WellSense.org
Member Services: 1-877-957-1300
REMEMBER: You have NH Medicaid and get the same services as someone on regular Medicaid. You can keep your current doctors as long as they work with the Health Plan you pick. Any extra services you get will depend on the Health Plan you pick.
Both Health Plans offer different programs to support overall wellness while still covering all of the same services as NH Medicaid. The extra supports you get will depend on which Health Plan you pick. Be sure to choose the one that is right for you! See Meet Your Health Plans to find out more about each Health Plan.
You should pick a Health Plan that has the health care providers and services you want to use. Use the tips below to decide which Health Plan is right for you.
If you want to keep the doctor you have now, you must pick a Health Plan that your doctor works with.
- STEP 1: Make a list of the doctors, clinics, hospitals and other health care providers you use now. Decide which ones you want to keep using.
- STEP 2: Find out which Health Plans your health care provider works with, by:
- Use the on-line search tool at https://nheasy.nh.gov/. Click the "Health Plan Provider Directory" button to search providers by name, group name, or city/town; OR
- Contact the Health Plan, and ask if your providers are in their network; OR
- Contact your provider office, and ask which Health Plan(s) they accept; OR
- Call the Medicaid Service Center toll free at 1-888-901-4999, and ask for help
- STEP 3: Pick a Health Plan that works with your provider. If your provider work with more than one Health Plan, pick the Health Plan with the extra services and programs you like best.
If you do NOT have a doctor or want to change doctors, compare the Health Plans to see which one offers the services and programs you like best
Both Health Plans offer the same basic benefits and programs, but some Health Plans offer extra services that you may want. Read Meet Your Health Plans to find out more about each Health Plan, and what special programs they have that may be of interest to you.
Note for foster parents:
If you have a child in your care that gets foster care services, contact the DCYF fiscal specialist about picking a Health Plan for the child in your care.
There are four (4) ways to find out which Health Plan your doctor or health care provider works with. You can:
- Call the Medicaid Service Center toll free at 1-888-901-4999, and ask which Health Plans your provider accepts OR
- Go online to https://nheasy.nh.gov/, and click on the "Health Plan Provider Directory" button to search providers by name OR
- Call your provider and ask them which Health Plan(s) they accept
- Call the Health Plan and ask if your providers are in their network
There are 3 ways to pick a Health Plan. You can:
- Call the Medicaid Service Center toll free at 1-888-901-4999; OR
- If you have a NH EASY account, log on to https://nheasy.nh.gov/ , and select the "Go Now" button in the Care Management box; OR
- Complete and return a "Health Plan Enrollment Form" that was sent to you
You have 60-days to pick a Health Plan. If you do not pick a Health Plan before the 60-days runs out, one will be picked for you.
Choosing a Health Plan using NH EASY is very simple. If you already have a NH EASY account, log in and select the 'Go Now' button in the Care Management box. With a NH EASY account, you can:
- Research - See a side-by-side comparison, and get more information on both of the Health Plans. You can also check to see which Health Plan your doctor works with. This will help you make pick the Health Plan that is best for you.
- Select - Pick a Health Plan or change the Health Plan you chose.
- History - View the history of your care management eligibility and Health Plan selections.
NH EASY is an EASY, fast, and private way to look at and manage your case online! Just follow these simple steps to join NH EASY:
- Go to https://nheasy.nh.gov/
- Select "Create Account" from the NH EASY homepage, enter your information and PIN (Personal Identification Number), and select "Next".
Your PIN was printed on a letter that came with your original Medicaid enrollment packet. If did not get a PIN, or no longer have it, select "Don't have a PIN?", and one will be mailed to you. When you get your PIN, go back to www.nheasy.nh.gov to create your account.
After you pick a Health Plan, you will get a letter from DHHS confirming your selection or "autoassigned" Health Plan. The Health Plan will send you a Welcome Packet with information about the services your Health Plan offers.
If you haven't already selected a primary care provider (PCP), your Health Plan will ask you to pick one. A PCP is the doctor that will manage most of your care. It is the doctor you see for regular check-ups or when you are sick.
You may choose the PCP you already use, or choose a different PCP as long as the provider you select works with your Health Plan.
Your Health Plan will also ask you questions about your health so they can better help you get the care you need.
Your Health Plan will also send you a new card. Don't throw your Medicaid Card away. You will still need it. You will still use your Medicaid card for some services, so show both cards to your doctor or pharmacist at each visit.
You can change your Health Plan if you are mandatory for any reason during the first 90-days you are covered by that the Health Plan. Voluntary MCM members can change Health Plans at any time.
You can also change Health Plans during the annual open enrollment period.
You can also change your Health Plan at any time when you have "good cause" If you believe you have a good cause, and want to change your Health Plan, contact Client Services at (800) 852-3345, ext 4344 (in state) or (603) 271-4344.
If you are not happy with a service or decision, you have the right to tell the Health Plan by filing a grievance or an appeal.
Complaints and Grievances
A grievance is a formal way to tell a Health Plan about a problem with something like customer service.
An appeal is a way to ask to change a decision made by a Health Plan. An example of an appeal is when a Health Plan does not approve a request for a service.
Want to know more about your right to complain or appeal? Look in your Health Plan member handbook under "Grievances and Appeals" or visit your Health Plan's
Not happy with the result of your Health Plan appeal? You can appeal to a unit within the Department whose main job is to hear appeals. Visit the Administrative Appeal Unit for more information on how to file an appeal .
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