Member Handbook TDD/TTY: NHHealthyFamilies.com

MEMBER HANDBOOK

Other Formats Available

The information in this booklet is about your New Hampshire Healthy Families benefits. If you need information in a different language, please call Member Services 1-866-769-3085 so we can help you.

Spanish: La información incluida en este folleto es acerca de sus beneficios del Plan de Salud New Hampshire Healthy Families Si necesita obtener la información en un idioma diferente, llame al Departamento de Servicios para Miembros al 1-866-769-3085 para que podamos ayudarle.

Interpreter Services

For members who do not speak English or do not feel comfortable speaking it, New Hampshire Healthy Families has a free service to help. This service is very important because you and your doctor must be able to talk about your medical or behavioral health concerns in a way you both can understand. Our interpreter services are provided at no cost to you and can help with many different languages. This includes sign language. We also have Spanish-speaking representatives available who can help you as needed. New Hampshire Healthy Families members who are blind or visually impaired can call Member Services for an oral interpretation. To arrange for interpretation services, call Member Services 1-866-769-3085 (TDD/TTY 1- 1-855-742-0123).

MEMBER HANDBOOK

Table of Contents

Other Formats Available ... 1

Interpreter Services ... 1

Table of Contents ... 2

WELCOME ... 5

Welcome to New Hampshire Healthy Families ... 5

Member Handbook ... 5

Your Provider Directory ... 6

New Hampshire Healthy Families Website ... 6

Member Advisory Committee ... 6

Quality Improvement (QI)... 7

How to Contact Us... 7

Other Important Phone Numbers ... 8

Your Member ID card ... 9

HOW YOUR PLAN WORKS ... 10

Service Areas Covered ... 10

Member Services... 10

NurseWise® ... 10

Membership and Eligibility Information ... 11

Eligibility ... 11

Major Life Changes ... 11

Open Enrollment ... 12 Disenrollment ... 12 Newborn Enrollment ... 13 BENEFITS ... 14 Covered Services ... 14 Benefits Grid ... 14

HOW TO OBTAIN HEALTHCARE ... 22

3 Easy Steps to Establish a Primary Care Provider Relationship and a Medical Home . 22 PCP Responsibilities... 23

Choosing Your PCP ... 23

Changing Your PCP ... 24

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Continuity and Transition of Care for New Members... 27

UTILIZATION MANAGEMENT ... 28

Medically Necessary Services... 28

Prior Authorization for Services ... 28

Second Medical Opinion ... 29

How to Get Medical Care When You Are Out of State ... 29

Out of Network Care ... 30

Referrals ... 30

Self-Referrals... 31

Urgent Care-After Hours ... 31

Emergency Care... 32

Emergency Transportation Services ... 33

Non-EmergencyTransportation Services... 33 Vision ... 34 Post-Stabilization Services ... 34 PHARMACY ... 34 Pharmacy Program ... 34 Prior Authorization ... 35

Emergency Drug Supply ... 35

Over-the-Counter Medications ... 35

Excluded Drugs ... 35

Filling a Prescription ... 36

Specialty Pharmacy Provider ... 36

HEALTH MANAGEMENT... 36

Health Risk Screening ... 36

Case Management... 37

Disease Management ... 38

Preventive Care ... 38

CentAccount® Program ... 40

Earlyand Periodic Screening, Diagnosis and Treatment (EPSDT)... 40

When You Are Pregnant ... 42

Pregnancy & Maternity Services ... 42

MEMBER SATISFACTION ... 44

Internal Grievance Process ... 44

How to File a Grievance ... 45

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When Does an Appeal Have to be Filed? ... 47

Expedited Appeals ... 47

Medicaid Fair Hearing for Appeals ... 47

Waste, Abuse, and Fraud (WAF) Program ... 48

Authority and Responsibility... 48

What to do if you get a Bill ... 50

Other Insurance... 50

Accidental Injury or Illness (Subrogation) ... 50

Member Rights and Responsibilities ... 50

Advance Directives ... 53

MEMBER HANDBOOK

WELCOME

Welcome to New Hampshire Healthy Families

New Hampshire Healthy Families is your new health plan. This Member Handbook describes your healthcare benefits and is designed to make it easy for you to make the most of your benefits and services.

You became a New Hampshire Healthy Families member because you live in New Hampshire; you currently receive Medicaid benefits, and are eligible for the New Hampshire Medicaid Care Management program. New Hampshire Healthy Families is a Managed Care Organization (MCO) overseen by the New Hampshire Department of Health and Human Services (DHHS). New Hampshire Healthy Families is a healthcare plan that gives you choices – from establishing a Medical Home by choosing your Primary Care Provider (PCP) to participating in special programs that help you stay healthy.

You may also visit our website at www.nhhealthyfamilies.comfor more information and services.

Member Handbook

The Member Handbook is a detailed guide to New Hampshire Healthy Families and your healthcare benefits. It is our contract with you. The Member Handbook explains your rights, your benefits, and your responsibilities as a member of New Hampshire Healthy Families. Please read this booklet carefully. It gives you information on your New Hampshire Healthy Families benefits and services such as:

 What is covered by New Hampshire Healthy Families

 What is not covered by New Hampshire Healthy Families

 How to get the care you need

 How to get your prescriptions filled

 What you will have to pay for your healthcare or prescriptions

 What to do if you are unhappy about your health plan or coverage

 Eligibility requirements

 Materials you will receive from New Hampshire Healthy Families

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Your Provider Directory

Visit the New Hampshire Healthy Families Provider Directory at www.nhhealthyfamilies.com to find a list of providers to choose from, including information on PCPs, specialists, Family Planning Providers, dentists, pharmacies, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs), Mental Health and Substance Abuse Providers, and hospitals. This online directory gives you the names, locations, office hours and telephone numbers, non- English language spoken by current contracted providers with New Hampshire Healthy Families and is free of charge.

At any time, you can request an additional copy at no charge by calling Member Services at 1- 866-769-3085. New Hampshire Healthy Families can also help you pick a PCP. You can also find the most current version of New Hampshire Healthy Families’ Provider Directory on the internet at www.nhhealthyfamilies.com.

Call your PCP’s office to make an appointment within 90 days of enrollment. If you need help, call Member Services at 1-866-769-3085. We will help you make the appointment.

New Hampshire Healthy Families Website

New Hampshire Healthy Families’ website helps you get the answers. Our website has resources and features that make it easy for you to get quality care. New Hampshire Healthy Families’ website can be found at www.nhhealthyfamilies.com. It also gives you information on your New Hampshire Healthy Families benefits and services such as:

 Member Handbook

 Provider Directory

 Current news and events

 Member self-service features

 Online form submission

 New Hampshire Healthy Families programs and services

Member Advisory Committee

You can help New Hampshire Healthy Families with the way our health plan works. We have a Member Advisory Committee that gives members like you a chance to share your thoughts and ideas with New Hampshire Healthy Families. At the meetings, you have a chance to talk about

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talk about your concerns with a variety of people. You also have a chance to tell us how we are doing. You may ask questions or share any concerns that you have about the delivery of services. Call Member Services 1-866-769-3085 if you would like to attend.

Quality Improvement (QI)

New Hampshire Healthy Families is committed to providing quality healthcare for you. Our primary goal is to improve your health and help you with any illness or disability. Our program is consistent with National Committee on Quality Assurance (NCQA) and Institute of Medicine (IOM) priorities. To help promote safe, reliable, and quality healthcare, our programs include:

 Conducting a thorough check on providers when they become part of the New Hampshire Healthy Families provider network.

 Monitoring the access that New Hampshire Healthy Families members have to all types of healthcare services.

 Providing programs and educational items about general healthcare and specific diseases.

 Sending reminders to you to get annual tests, such as an adult physical, cervical cancer screening, and breast cancer screening.

 Investigating your concerns regarding the healthcare you have received. If you have a concern about the care you received from your doctor or any service provided by New Hampshire Healthy Families, please contact us at 1-866-769-3085.

New Hampshire Healthy Families believes that getting input from members, like you, can help make the services and quality of our programs better. We conduct a member survey each year that asks questions about your experience with the healthcare and services you are receiving. If you receive one of our member surveys, please be sure to fill out the survey and drop it back in the mail.

How to Contact Us

New Hampshire Healthy Families

2 Executive Park Drive Bedford, NH 03110 www.nhhealthyfamilies.com

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Member Services ...1-866-769-3085

TDD/TTY line ...1- 855-742-0123 Member Services Fax ...1- 877-502-7255 New Hampshire Relay Services ...711

Behavioral Health Services ...1- 888-282-7767

Other Important Phone Numbers

Non-Emergency Transportation (Access2Care) ... 1-866-769-3085 Vision Services ...1-866-769-3085 Emergency Services ... Call 911

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Your Member ID card

When you enroll in New Hampshire Healthy Families, you will receive a New Hampshire Healthy Families Member ID Card within 10 calendar days of enrollment. This card is proof that you are enrolled with New Hampshire Healthy Families. You need to keep this card with you at all times. Please show this card every time you go for any service under the New Hampshire Healthy Families program. The New Hampshire Healthy Families ID card will show your name, Medicaid ID#, PCP name and number. If you do not get your New Hampshire Healthy Families ID card within a few weeks after you join our plan, please call Member Services at 1-866-769- 3085. We will send you another card.

Here is an example of your New Hampshire Healthy Families ID card Front  Name  Date of Birth  Medicaid ID#  PCP Name/Number  PCP effective date

 Pharmacy vendor information

Back

 Important Member & Provider Phone

Numbers (24/7 hotline #)  Medical paper claims address  Website address

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HOW YOUR PLAN WORKS

Service Areas Covered

New Hampshire Healthy Families is a health plan available through New Hampshire Department of Health and Human Services (DHHS). New Hampshire Healthy Families’ service area includes all counties in New Hampshire.

Member Services

Our Member Services department will tell you how New Hampshire Healthy Families works and how to get the care you need. The Member Services call center can help you to:

 Find a PCP.

 Schedule an appointment with your PCP.

 Obtain a new ID card.

 Obtain information about covered and non-covered benefits.

 Obtain a list of health plan providers.

 Report potential fraud issue.

 Request new member materials.

 Obtain information about case management.

Please call 1-866-769-3085 (TDD/TTY 1-855-742-0123). We are open Monday through Friday from 8:00 a.m. to 5:00 p.m. (expanded hours to 8:00 p.m. available three days per week) Calls received after business hours are sent directly to NurseWise. NurseWise nurses are available 24 hours a day, seven (7) days a week, including holidays.

NurseWise

®

NurseWise is a free health information phone line. NurseWise is ready to answer your health questions 24 hours a day – every day of the year. NurseWise is staffed with registered nurses. These nurses have spent lots of time caring for people. They are ready and eager to help you. The services listed below are available by calling NurseWise, New Hampshire Healthy Families’ 24- hour nurse hotline at 1-866-769-3085.

 Medical advice.

 Health information library.

 Answers to questions about your

 Advice about a sick child.

 Help with scheduling PCP appointments.

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Sometimes you may not be sure if you need to go to the emergency room (ER). Call NurseWise. They can help you decide where to go for care. If you have an emergency, call 911 or go to the nearest ER.

Membership and Eligibility Information

Eligibility

You must have Medicaid and be eligible for the New Hampshire Medicaid Care Management program in order to be eligible for this health plan. New Hampshire Healthy Families does not determine eligibility. The populations covered will include TANF, CHIP, ABD, and voluntary dual eligibles and Foster Care participation in Step One; Step Two will expand coverage to include mandatory dual eligibles and Foster Care, as well as waiver services and long term care services; Step Three includes further expansion to additional eligibles as identified as a result of the Patient Protection and Affordable Care Act.

Major Life Changes

Life changes might affect your eligibility with New Hampshire Healthy Families. If you have a major change in your life, please contact your eligibility source (such as your local Social Security Administration office, Office of Administration for New Hampshire, county office, or New Hampshire Medicaid Regional office) within 10 days after the change happens (or within 10 days after you realize the change has taken place). You should also contact Member Services 1-866- 769-3085.

Some examples of major life changes are:

 A change in your name.

 Move to a different address.

 A change in your job.

 A change in disability.

 Pregnancy.

 Moving to a new county or out of state.

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Open Enrollment

There will be an annual open enrollment period for New Hampshire Medicaid Care Management program members that Medicaid will tell you about. During this period, you may choose another MCO health plan for any reason. If you want to change your health plan during open enrollment, please contactthe Enrollment Center at 1-888-901-4999. You can also visit the state website at http://www.dhhs.nh.gov/index.htm.

Disenrollment

You may request to disenroll from New Hampshire Healthy Families with or without cause. DHHS procedures must be followed for all disenrollment requests. Your request for disenrollment must be directed to DHHS either orally or in writing. We will ensure your right to disenroll is not restricted in any way.

To request disenrollment, contact the Enrollment Center at 1-888-901-4999, or in writing at:

Division of Client Services

NH Department of Health & Human Services 129 Pleasant Street

Concord, NH 03301

You may request disenrollment without cause for the following:

 During your initial ninety (90) day enrollment period.

 Any time for members who enroll on a voluntary basis.

 For twelve (12) months for any members who are auto-assigned to a MCO and who have an established relationship with a primary care provider that is only in the network of a non-assigned MCO.

 During annual open enrollment.

 For sixty (60) days upon automatic reenrollment if the temporary loss of Medicaid eligibility has caused you to miss the annual disenrollment opportunity

 When DHHS imposes an intermediate sanction on New Hampshire Healthy Families. You may request disenrollment with cause for the following:

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 If you need related services to be performed at the same time and not all related services are available within the network.

 Your PCP or another provider determines receiving the services separately would subject you to unnecessary risk, poor quality of care, lack of access to services covered under the plan, or lack of access to providers experienced in dealing with the member’s healthcare needs.

We will let DHHS know in writing within three (3) business days if one of the following occurs:

 Member no longer resides in the State of New Hampshire

 Member dies

 Member no long qualifies for medical assistance under one of the Medicaid eligibility categories in the targeted population

 Fraudulent use of the member ID card

New Hampshire Healthy Families shall not disenroll a member for the following reasons:

 Adverse change in a member’s health status

 Utilization of medical services

 Diminished mental capacity

 Uncooperative or disruptive behavior resulting from his or her special needs

 Abuse of substances, prescribed or illicit, and any legal consequences resulting from substance abuse

New Hampshire Healthy Families will not directly disenroll any member if your disenrollment is not provided on the state Enrollment file.

Newborn Enrollment

For all eligible New Hampshire Healthy Families members who give birth, their Newborns will be covered under the mother’s health plan, at the time of the child’s birth. You will have up to 60 days to contact New Hampshire Healthy Families to enroll your child.

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BENEFITS

Covered Services

This section describes your New Hampshire Healthy Families covered benefits and benefit limits. With New Hampshire Healthy Families, you are entitled to receive medical services and benefits listed in this section. You are responsible for any non-covered services. Covered benefits are listed below.

Please Note:

 New Hampshire Healthy Families will not limit or deny services because of a condition you already have.

 For services which are medically necessary and covered by New Hampshire Healthy Families, you will not have any co-payments (co-pays), deductibles, or other cost sharing.

 If you receive healthcare services which are not medically necessary or if you receive care from doctors who are out of the New Hampshire Healthy Families network, you may be responsible for payment. If you have questions about medical necessity or which doctors are in your network, call Member Services at 1-866-769-3085.

Benefits Grid

This list does not intend to be an all-inclusive list of covered services. All services are subject to benefit coverage, limitations, and exclusions as described in the plan coverage guidelines. Some services require prior authorizations.

Covered Services Benefit Limitation Comments Adult Day Care Limited to age 18 and up

Allergy Services

Ambulatory Surgery Center Anesthesia Services

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Covered Services Benefit Limitation Comments

Bariatric Surgery Certain restrictions and limitations may apply

Prior Authorization Required.

Behavioral Health Services Includes Community Based, Inpatient and Outpatient Services, Community Mental Health Center Services, Psychology Services. Services administered by Cenpatico Behavioral Health. 1- 866-769-3085 Birthing Centers Chemotherapy

Dental Services For persons age 21 and over, limited to treatment of acute pain or infection. Covered dental services for members under 21 are those rendered in a physician’s office as part of the standard EPSDT exam.

Diabetic Education Dialysis

Durable Medical Equipment (DME)

Authorization Required Early Periodic Screening

Diagnosis and Treatment

For members less than 21 years old

Only for members 20 and under

Emergency Room Services Enteral & Parenteral Nutrition for Home Use

Family Planning

Fluoride Varnish For members age 6 to 36 months, limited to twice per year.

(PCP/Pediatrician visit)

FQHC & RHC Services Hearing Aids and Related Services

Limited to one service every 2 years since the last date of service.

High Cost Radiology (MRA,MRI,CT,PET Scan) Authorization Required.

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Covered Services Benefit Limitation Comments

Hospice Care

Hospital Services: Inpatient Hospital Services: Outpatient

Hysterectomy Not covered if performed for the purpose of an individual permanently incapable of reproducing;

Consent Form Required

Laboratory Services

Medical Services Clinic Limits based on the type of service delivered except for Methadone maintenance or for immunizations.

Authorization required

Maternity Care Services Includes:

 Nurse mid-wife services

 Pregnancy related services

 Services for conditions that might complicate pregnancy

Medical Nutrition Therapy Authorization

Required. Orthotics & Prosthetics (O&P) Authorization

Required. Oxygen and Respiratory

Services

Pain Management

Personal Care Services Limited to over the age of 18 Physician, and Nurse

Practitioner Services

Podiatrist Services 4 per calendar year Private Duty Nursing

Prescription Drugs Please refer to

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Covered Services Benefit Limitation Comments

$1 co-pay generic $2 co-pay brand name Some exclusions apply

(PDL) for covered medications. Contact Member Services for information.

Preventative Care

Radiology and x-rays 15 per calendar year. Sterilization Procedures Age 21

and over

Consent Form Required Therapy (OT, PT, ST) Services

(Outpatient)

Limited to 80, 15-minute units per calendar year. The 80 units may be for one type of therapy or any combination.

Transplant Service

Transportation (Emergency Ambulance)

Transportation (Non Emergent Medical)

Must be transportation to medically necessary services Vision Services and Eyewear Examinations are covered once

per calendar year. Eyeglasses are covered if there is a ½ diopter change.

Wheelchair Van Service 24 trips per calendar year, either one-way or round trip.

Extensions to the service limits may be granted.

Value Adds and Additional Benefits

Expected Programs Comments CentAccount Well Child visits, birth to 15

months of life (EPSDT Visit)

6 visits within the first 15 months of life, $10 incentive payment. One reward per lifetime. Child well-care visits, ages 2-

20

1 visit each year, $10 incentive payment. One

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(Wellness Screening)

reward per calendar year

Well care visits, adults aged 21 and over

(Wellness Screening)

1 visit each year, $10 incentive. One reward per calendar year.

Diabetes management, all identified diabetics

(Wellness Screening)

Includes A1c testing, LDL screening, eye exam, and nephropathy testing, $20 incentive payment. One reward per calendar year for completing all four activities.

Prenatal visits, pregnant women identified and enrolled in Start Smart Program. To enroll, fill out Notification of Pregnancy (NOP) form or call member services.

(Pregnancy- Start Smart)

Attend the 3rd, 6th, and 9th visit and be enrolled in Start Smart Program, $10 incentive payment. Incentive paid out upon confirmation of office visits with provider.

Post-partum visit

(Pregnancy – Start Smart)

Attend the post-partum visit 21-56 days after the birth, $10 incentive payment.

Start Smart for Your Baby 17-P program

Start Smart Baby Shower Program

Start Smart for Your Baby texting program

Nurse Wise 24/7 nurse hotline Nurtur Disease Management Asthma

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Diabetes

Congestive Heart Failure (CHF) Coronary Artery Disease (CAD) COPD

MemberConnections

Connections Plus Available to high-risk

members Fluvention

Interpreter services – telephonic / face to face

Covered upon request free of charge

Puff Free Pregnancy A specialized smoking cessation program for high- risk pregnant women

Smoking Cessation A disease & case management program for high-risk

members that choose to quit smoking

Exclusions

What Does New Hampshire Healthy Families Not Cover?

What is and is not covered may change from time to time. When there are changes, we will send you a notice.

Benefits not covered by New Hampshire Healthy Families may be covered by state or federal programs. To receive information about eligibility for these benefits, contact the New Hampshire Department of Health and Human Services (DHHS) at 1 (800) 852-3345/ TDD Number of 1-800735-2964, or 2-1-1 New Hampshire at 1-866-444-4211/ TDD Number: 1-603-634-3388

The following services and supplies are not covered or are limited under this plan (Please keep in mind that this may not be an all-inclusive list):

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If a service is marked as “Not Covered,” that means neither New Hampshire Healthy Families nor the state will pay for these services. If you seek care for any “Not Covered” service, you will be responsible for payment of any charges.

Non –Covered Services Additional Detail Comments Abortions (Voluntary) Some abortions are

covered in limited circumstances

Not Covered

Alternative Medicine Acupuncture, Biofeedback

Not Covered

Chiropractic Care Not Covered

Cosmetic or plastic surgery Not Covered

Diagnosis and treatment of infertility, impotence and sexual dysfunction

Not Covered

Experimental procedures, drugs and equipment

Not Covered

Gender reassignment surgery Not Covered

Personal Comfort Items Not Covered

Non-Medical Equipment Not Covered

Physical exams required for employment, insurance or licensing.

Not Covered

Radial Keratotomy Not Covered

Services not allowed by federal or state law

Not Covered Weight reduction and control

services

This includes: weight loss drugs or products, gym memberships or equipment for the purpose of weight reduction.

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Intermediate Care Facility MR Covered by FFS Medicaid Medicaid to Schools Services Covered by FFS Medicaid

Dental Benefit Services Covered by FFS Medicaid

Acquired Brain Disorder Waiver Services

Covered by FFS Medicaid Developmentally Disabled

Waiver Services

Covered by FFS Medicaid Choices for Independence

Waiver Services

Covered by FFS Medicaid In Home Supports Waiver

Services

Covered by FFS Medicaid Skilled Nursing Facility Covered by FFS Medicaid Skilled Nursing Facility Atypical

Care

Covered by FFS Medicaid Inpatient Hospital Swing Beds,

SNF

Covered by FFS Medicaid Intermediate Care Facility

Nursing Home

Covered by FFS Medicaid Intermediate Care Facility

Atypical Care

Covered by FFS Medicaid Inpatient Hospital Swing Beds,

ICF

Covered by FFS Medicaid

Glencliff Home Covered by FFS Medicaid

Developmental Services Early Supports and Services

Covered by FFS Medicaid New Substance Abuse Benefit

Allowing Masters Licensed Alcohol and Drug Abuse Counselors (MLDAC)

Covered by FFS Medicaid

Home Based Therapy – DCYF Covered by FFS Medicaid Child Health Support Service –

DCYF

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Intensive Home and Community

Services – DCYF

Covered by FFS Medicaid Placement Services – DCYF Covered by FFS Medicaid Private Non-Medical

Institutional For Children – DCYF

Covered by FFS Medicaid Crisis Intervention – DCYF Covered by FFS Medicaid

HOW TO OBTAIN HEALTHCARE

New Hampshire Healthy Families works with a large group of doctors, specialists, hospitals and other healthcare providers. This group is called a network. In most cases, you need to get care within the New Hampshire Healthy Families network. Except for emergency, urgent care & family planning, all services must be obtained through New Hampshire Healthy Families network providers or pre-approved for out of network providers.

3 Easy Steps to Establish a Primary Care Provider Relationship and a

Medical Home

1) Choose a doctor. If you do not choose one, New Hampshire Healthy Families will choose one for you. You can find this information on your member ID card. You will be able to switch to a different doctor during our new member welcome call.

2) Within 90 days of enrolling, make an appointment with your doctor. 3) Talk to your doctor about any health problems you are having.

What is a Primary Care Provider (PCP)

When you enroll in New Hampshire Healthy Families, you must choose a Primary Care Provider (PCP). Your PCP is a doctor you see on a regular basis to take care of your medical needs. You should receive all of your basic medical care from your PCP. You can call your PCP when you are sick and do not know what to do. Seeing your doctor for regular check- ups helps you find health problems early. This can help prevent going to the emergency room. If you have never seen your PCP, as soon as you join New Hampshire Healthy

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Families you should call your PCP, introduce yourself as a new member and make an appointment for a preventive visit. It is best to not wait until you are sick to meet your doctor for the first time.

What is a Medical Home

Having a Medical Home means having a partnership between you and your PCP. Your PCP will lead and guide your care, assisting in coordinating any services you might need.

PCP Responsibilities

Your PCP will:

 Make sure that you get all medically necessary services in a timely manner.  Follow-up on the care you get from

other medical providers.

 Take care of referrals for specialty care and services offered.

 Provide any ongoing care you need.  Update your medical record, including

keeping track of all the care that you get with your PCP and specialists.

 Provide services in the same manner for all patients.

 Give you regular physical exams.  Provide preventive care. (page 38)  Give you regular immunizations.

 Make sure you can contact him/her or another doctor at all times.

 Discuss what advance directives are and file the advance directives appropriately in your medical record.

New Hampshire Healthy Families believes that seeing your PCP is important. New Hampshire Healthy Families offers a program called the CentAccount® program. You can earn rewards for healthy behaviors. More information on this program is in your new member welcome packet.

Choosing Your PCP

The New Hampshire Healthy Families Provider Directory is a list of all the providers in New Hampshire Healthy Families’s network, including doctors and hospitals. It shows the

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addresses, phone numbers, and any languages the provider may speak. When picking a PCP, look for one of the following kinds of providers:

 Pediatricians

 Family /General Practitioners

 Internal Medicine

 Obstetricians/Gynecologists

 Registered Nurse Practitioners

 Physician Assistants (under the supervision of a physician)

 Advanced Registered Nurse Practitioners (ARNP)

Specialists can be your PCP for special needs, upon request. Because New Hampshire Healthy Families is always working to have the best provider network for all of its members, please check the New Hampshire Healthy Families website at www.nhhealthyfamilies.com to see if new providers have been added. If you want to know more about the PCP before you choose, please call Member Services at 1-866-769-3085.. You may also see a list of network providers at www.nhhealthyfamilies.com.

Changing Your PCP

You may change your PCP at any time if:

 Your PCP is no longer in your area

 You are not satisfied with your PCP's services

 The PCP does not provide the services you seek because of religious or moral reasons

 You want the same PCP as other family members

You must notify us when you change your PCP. You can do this in several ways. Call Member Services at 1-866-769-3085.

Making an Appointment with Your PCP

Once you have selected a PCP, make an appointment to meet with your doctor within 90 days and at least annually. This will give you and your doctor a chance to get to know each other. Your doctor can give you medical care, advice, and information about your health. Call your PCP’s office to make an appointment. Remember to take your member ID card

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with you every time you go to the doctor's office. If you have difficulty getting an appointment with or seeing your doctor, please call Member Services at 1-866-769-3085.

Scheduling/Appointment Waiting Times

Network providers will be open at reasonable times. You will get an appointment based on your medical needs. You should be given an appointment within the following time frames:

Type of ProviderAppointment Scheduling Time Frame Preventive Care Within thirty (30)

calendar days Regular and Routine Within ten (10) calendar

days

Clinical Assessment post discharge (Transitional) Within seven (7) calendar days of discharge Home Care Nurse Within two (2) calendar

days of discharge

Urgent Within forty-eight (48)

hours

Emergency Immediately, or refer to ER

Behavioral Health Care Scheduling Time Frame Regular and Routine An appointment within 10

business days for a routine office visit

Clinical Assessment post discharge (Transitional) Within seven (7) calendar days of discharge Home Visit with Registered Counselor post discharge Within two (2) calendar

days

Urgent Within 48 hours

Emergency Within 6 hours for a non- life threatening

emergency. Immediately for life threatening emergency.

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After Hours Appointments with Your PCP

You can call your PCP's office for information on receiving after hours care in your area. If you have a medical problem or question and cannot reach your PCP during normal office hours, you can call NurseWise, New Hampshire Healthy Families’ 24-hour medical nurse line at 1-866-769-3085.to speak to a nurse. If you have an emergency, call 911 or go to the nearest ER.

NOTE: Except for emergency & family planning, all services must be obtained through New Hampshire Healthy Families network providers or pre-approved for out of network providers.

IMPORTANT: If you cannot keep an appointment, please call the doctor’s office to cancel at least 24 hours in advance. If you need to change an appointment, call the doctor’s office as soon as possible. They can make a new appointment for you. If you need help getting an appointment, call Member Services at 1-866-769-3085.

NOTE: Any requests made on or after the 15th of the month will be effective the first day of the following month.

What to Do if Your Provider Leaves the New Hampshire Healthy

Families Network

If your PCP is planning to leave the New Hampshire Healthy Families provider network, we will send you a notice at least 30 calendar days before the date this occurs. We will automatically reassign you to another PCP. We will send you a new member ID card identifying your new PCP. You can also change your PCP by calling Member Services at 1- 866-769-3085.

New Hampshire Healthy Families may approve visits with your doctor for up to 90 days after he/she leaves the network. We can do this if you are in active treatment with your doctor. Members in the second or third trimester of pregnancy can keep the same doctor until after the first post-partum visit. During this time, we will help you find a new doctor. You will receive the same covered services. The doctor must agree to:

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 Treat you for your healthcare needs.

 Accept the same payment rate from New Hampshire Healthy Families.

 Follow New Hampshire Healthy Families’ quality assurance standards.

 Follow New Hampshire Healthy Families’ policies about prior authorization and using a treatment plan.

 Provide necessary medical information to you related to your care.

Continued coverage is only available if your PCP or specialist was not terminated by New Hampshire Healthy Families due to quality of care.

Continuity and Transition of Care for New Members

Sometimes new members are getting care from a doctor that is not in New Hampshire Healthy Families’ provider network. In some cases, you may be allowed to continue care with your doctor for up to 30 days. In order to have your previous doctor’s services continue, they must be prior authorized by New Hampshire Healthy Families. If you have questions, call Member Services at 1-866-769-3085.

New members in the second or third trimester of pregnancy can keep the same doctor until you have had your baby and completed your first post-partum visit. If you are a member who is terminally ill, you may continue to see your doctor for your care. In order to have your previous doctor’s services continue, they must be prior authorized by New Hampshire Healthy Families. If you have questions, call Member Services at 1-866-769-3085.

If you are a member leaving our plan to another plan and have ongoing medical care, we will assist you in transitioning your services to the new plan. New Hampshire Healthy Families’ staff will reach out to the new plan and help facilitate the transition of your care. For members in active care leaving New Hampshire Healthy Families, we will communicate active services and coordinate with the new plan to ensure a smooth transition without interruption of care. New Hampshire Healthy Families will share your care plan including authorization of active services to the new plan upon request.

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UTILIZATION MANAGEMENT

Medically Necessary Services

Covered services that you get must be medically necessary. This means getting the right care, at the right place, at the right time. New Hampshire Healthy Families uses nationally recognized guidelines, as well as, licensed medical personnel to check medical necessity, meaning we utilize established medical criteria and experience staff to look for services that are reasonable and necessary to protect life, to prevent significant illness or significant disability, or to relieve severe pain, through the diagnosis or treatment of disease, illness, or injury. New Hampshire Healthy Families does not reward its network providers or their staff to deny care.

Prior Authorization for Services

When you need care, always start with a call to your PCP. Some covered services may require prior authorization or review by New Hampshire Healthy Families before services are provided. This includes services or visits to an out of network provider and some specialists. Home health services and some surgeries also need to be reviewed. Your doctor can tell you if a service needs prior authorization. The list is on New Hampshire Healthy Families’ website at www.nhhealthyfamilies.com. You can also call Member Services at 1-866-769-3085 to see if something needs to be reviewed by New Hampshire Healthy Families.

Your doctor will give us information about why you need the service. New Hampshire Healthy Families will look to see if the service is covered and that it is appropriate. New Hampshire Healthy Families clinical staff will make the decision as soon as possible, based on your medical condition. Standard decisions are made within 14 calendar days. If the service is urgent, the decision will be made within three (3) business days. We will let you and your doctor know if the service is approved or denied. If you or your doctor is not happy with the decision you can ask us to make a second review. This is called an appeal. See the “Member Satisfaction” section in your Member Handbook for more information about appeals.

If there are any major changes to the prior authorization process, we will let you and your doctors know right away.

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Second Medical Opinion

You have the right to a second opinion about your treatment choice. This means talking to a different doctor about an issue to see what they have to say. The second doctor is able to give you their point of view. This may help you decide if certain services or methods are best for you. If you want a second opinion, tell your PCP.

Your PCP or New Hampshire Healthy Families’ Member Services can help you find a doctor to give you a second opinion. You may choose any New Hampshire Healthy Families network provider. If you are unable to find a doctor in the New Hampshire Healthy Families network, we will help you find a doctor outside the network. If you need to see an out of network provider for the second opinion, it must be prior approved by New Hampshire Healthy Families. Second opinions are covered by New Hampshire Healthy Families at no cost to the Member.

Any tests that are ordered for a second opinion should be given by a doctor in the New Hampshire Healthy Families network. Tests requested by the doctor giving you a second opinion must be prior approved by New Hampshire Healthy Families. Your PCP will look at the second opinion and help you decide on the best treatment plan.

How to Get Medical Care When You Are Out of State

If you are out of the area and have an emergency, call 911 or go to the nearest ER. Be sure to call us and report your emergency within 48 hours. You do not need prior approval. New Hampshire Healthy Families will cover only medically necessary emergency services out of state.

If you are out of state and have an urgent problem, go to an urgent care clinic or you may go to a PCP. Be sure to show your New Hampshire Healthy Families ID card prior to receiving services.

The two situations where you are covered for services out of state are as follows:

 You are out of state and you have a medical or behavioral health emergency. You can go to an ER in any state if you have a true medical or behavioral health emergency. If you are seen at an out-of-state hospital for an emergency, your follow up care must be with a New Hampshire Healthy Families network provider.

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You may also need to contact your PCP to get a referral if you need to see a specialist.

 It is determined that you need special care that you cannot receive in New Hampshire. If New Hampshire Healthy Families approves, the cost of the care you get in the other state will be covered. Members are not covered for any services outside of the United States.

Out of Network Care

Out of network emergency services do not need approval from New Hampshire Healthy Families. All other covered services from an out of network provider need prior authorization by New Hampshire Healthy Families. We will first check to see if there is a network provider that can treat your medical condition. If there is not, we will help you find an out of network provider. You will be financially responsible for payment of the out of network service(s) if New Hampshire Healthy Families did not approve the visit or service. If you have questions, call Member Services at 1-866-769-3085. New Hampshire Healthy Families will notify you when the referral is approved.

Referrals

You may need to see a certain doctor for specific medical problems, conditions, injuries, and/or diseases. Talk to your PCP first. Your PCP will refer you to a specialist in the New Hampshire Healthy Families network who can diagnose and/or treat your specific problem.

Do not go to a specialist without being referred by your PCP. Generally, a specialist will not

be able to see you without approval from New Hampshire Healthy Families and from your PCP. There are exceptions and they are listed in the “Self-Referrals” section of your Member Handbook. Always make sure you have a referral from your PCP first. If you have questions about getting a referral, call Member Services at 1-866-769-3085.

Some conditions may need ongoing care from a specialist. New Hampshire Healthy Families will allow your PCP to give a standing referral to a specialist in the New Hampshire Healthy Families network when:

 The specialist in New Hampshire Healthy Families’ network agrees to a treatment plan for you.

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 The specialist’s services to be provided are part of the benefits covered by New Hampshire Healthy Families.

NOTE: If your specialist refers you to another specialist, your specialist may need to obtain authorization by New Hampshire Healthy Families and your PCP.

Self-Referrals

You may self-refer for certain covered services. No approval is required from your PCP or New Hampshire Healthy Families for these services.

You may receive benefit coverage for the following services whether or not the doctor is in the New Hampshire Healthy Families provider network. You can self-refer for these services:

 Emergency services.

 Family Planning services and supplies.

 Women’s preventive health services.

 Treatment of women’s acute health conditions.

Urgent Care-After Hours

Urgent Care is not Emergency Care. Urgent Care is needed when you have an injury or illness that must be treated within 48 hours. It is usually not life threatening, yet you cannot wait for a visit to your PCP.

Only go to the emergency room if your doctor tells you to go or you have a life-threatening emergency. When you need urgent care, follow these steps:

 Call your PCP. The name and phone number are on your New Hampshire Healthy Families ID card. Your PCP may give you care and directions over the phone.

 If it is after hours and you cannot reach your PCP, call NurseWise 1-866-769-3085 (TDD/TTY 1-855-742-0123). You will be connected to a nurse. Have your New Hampshire Healthy Families ID card number handy. The nurse may help you over the phone or direct you to other care. You may have to give the nurse your phone number. During normal office hours, the nurse will assist you in contacting your PCP.

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If you are told to see another doctor or go to the nearest hospital emergency room, bring your New Hampshire Healthy Families ID card. Ask the doctor to call your PCP or New Hampshire Healthy Families.

Emergency Care

New Hampshire Healthy Families covers emergency medical services 24 hours a day, seven (7) days a week. Emergency services are required to treat an accidental injury or an onset of what reasonably appears to be a medical condition. An emergency arises when the lack of medical attention could be expected by a reasonable layperson to result in jeopardy to a member’s health or, in the case of a pregnant woman, the health of her unborn child.

When to go to the ER  Broken bones.

 Gun or knife wounds.

 Bleeding that will not stop.

 You are pregnant, in labor and/or bleeding.

 Severe chest pain or heart attack.

 Drug overdose.

 Poisoning.

 Bad burns.

 Shock (you may sweat, feel thirsty or dizzy or have pale skin).

 Convulsions or seizures.

 Trouble breathing.

 Suddenly unable to see, move or speak.

When NOT to go to the ER

 Flu, colds, sore throats, and earaches.

 A sprain or strain.

 A cut or scrape not requiring stitches.

 To get more medicine or have a prescription refilled.

 Diaper rash.

Emergency rooms are for emergencies. If you can, call your doctor first. If your condition is severe, call 911 or go to the nearest hospital. You do not need a doctor's approval. If you are not sure if it is an emergency, call your PCP. Your PCP will tell you what to do. If your PCP is not available, a doctor taking calls can help. There may be a message telling you what to do. You can also call NurseWise, our 24-hour medical advice line 1-866-769-3085 (TDD/TTY 1-855-742-0123) if you have questions.

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It is okay if the hospital does not belong to the New Hampshire Healthy Families network. You can use any hospital if it is an emergency. You or someone acting on your behalf MUST call your PCP and New Hampshire Healthy Families within 48 hours of admission. This helps your PCP to provide or arrange for any follow-up care that you may need. We will help you get follow-up care. Call us 1-866-769-3085 (TDD/TTY 1-855-742- 0123).

Emergency Transportation Services

New Hampshire Healthy Families covers emergency ambulance ground transportation to the nearest hospital for emergency care. Ambulance transportation to the hospital emergency room in non-emergency situations is not a covered service under New Hampshire Healthy Families and you may have to pay for it. Ambulance transportation from a healthcare facility to another healthcare facility is covered only when it is medically necessary and it has been arranged and approved by a New Hampshire Healthy Families network provider.

Non-Emergency Transportation Services

If you do not have a car or anyone available to give you a ride, as a New Hampshire Healthy Families member, we can help you get to your medical appointments as well as your state- covered dental appointments. Transportation is covered for all medically necessary services. New Hampshire Healthy Families is excited to offer this service through Access2Care.

If you need help getting to your medical appointment call Access2Care at 1-866-769-3085 1- XXX-XXX-XXXX. You must call at least three (3) business days before your appointment. Urgent medical trips can be requested with less than 3 days’ notice, and we may check with your doctor to make sure the appointment is urgent. If you have an emergency and you need help getting to an emergency room, you need to call 911.

What information do I need to know when I call?

 You Medicaid number

 The street address including city and zip code of your pick up location and the destination address and telephone number

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 If you use a wheelchair or other equipment to get to your appointments

 For minors 16 and under the name of the adult traveling with the child

You should be ready one hour before your appointment. The driver will call you 24 hours before your appointment to confirm the exact pick up time. If your ride is 15 minutes past pick up time, please call Access2Care at 1-866-769-3085

If you go to more than one appointment, to the same location, in the same week you need to call us. Please call Access2Care as soon as possible so that we can confirm we have your ride to and from your appointment.

Vision

New Hampshire Healthy Families allows members to choose from a standard selection of frames and lenses. Members can choose to opt out of the standard benefit and select frames outside of the standard selection. An allowance will be approved as a credit toward the purchase of glasses with single vision lenses, or glasses with bifocal or trifocal lenses. Any charges exceeding the allowance are the Member’s responsibility.

Post-Stabilization Services

These are services that are needed to stabilize your condition after an emergency. They do not require prior authorization. It does not matter whether you receive the emergency care in or outside of the New Hampshire Healthy Families network. We will still cover services to make sure you are stable after an emergency.

PHARMACY

Pharmacy Program

You can get prescriptions through your New Hampshire Healthy Families coverage if you go to a pharmacy that takes New Hampshire Healthy Families members. There are some drugs that may not be covered through New Hampshire Healthy Families. A New Hampshire Healthy Families pharmacy can let you know which drugs are not covered, or help you find

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another drug that is covered. You can also ask your doctor about what drugs are covered, and what is best for you.

Prior Authorization

Some drugs have limits or require prior approval before your prescription can be filled. If prior approval is needed the pharmacy will inform your doctor. If your doctor feels you have a medical reason to get the drug, they can ask New Hampshire Healthy Families for coverage authorization. If New Hampshire Healthy Families does not grant the approval you and your doctor will be notified of the decision and given instruction on how to file an appeal.

Emergency Drug Supply

If your doctor cannot be reached to approve a prescription, you may be able to get a 72 hour (three day) emergency supply. Pharmacies that are contracted with US Script are authorized to provide a 72 hour supply and will be reimbursed for the ingredient cost and dispensing fee drug.

Over-the-Counter Medications

Some covered over-the-counter (OTC) drugs are covered through New Hampshire Healthy Families. In order for an OTC drug to be covered, it must be written on a valid prescription by a licensed doctor. If you purchase OTC drugs without a prescription from a doctor you will have to pay for them.

Excluded Drugs

Some drugs are not covered through New Hampshire Healthy Families. These include, but are not limited to:

 Drug Efficacy Study Implementation (DESI) drugs

 Fertility agents

 Topical Minoxidil

 Vaniqa®

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Filling a Prescription

New Hampshire Healthy Families covers most of the drugs your doctor says you need. Your doctor will write a prescription so you can take it to the pharmacy, or may be able to send the prescription for you. New Hampshire Healthy Families provides prescriptions for its members through pharmacies that are contracted with US Script. You can get your prescriptions filled at most pharmacies. It is important that you show your New Hampshire Healthy Families ID card at the pharmacy. If you need help finding a pharmacy or have trouble getting your drugs, call New Hampshire Healthy Families at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

Specialty Pharmacy Provider

Certain drugs are only covered when they are supplied by New Hampshire Healthy Families’ specialty pharmacy provider. CVS/Caremark is New Hampshire Healthy Families’ specialty pharmacy provider. These drugs are not available at retail pharmacies. CVS/Caremark provides you with the following services:

• They can deliver drugs to your home or doctor’s office. • They have staff that can answer questions about drugs. • They are available 24 hours a day, seven (7) days a week. • They can give you information, materials, and ongoing support.

• CVS/Caremark wants to help you take the drugs the right way to manage your health condition.

If you have questions about any of the pharmacy program, call Member Services at 1-866- 769-3085.

HEALTH MANAGEMENT

Health Risk Screening

New Hampshire Healthy Families wants to know how we can better serve you. One way we do this is by asking you to fill out the Health Risk Screening form found in your Welcome Packet. This form gives us information to determine your needs. Once you fill out the form,

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please send it back to us right away in the postage-paid envelope we have provided for you. You can also fill out this form on our website www.nhhealthyfamilies.com. If you have questions about the form, please call us at 1-866-769-3085.

Case Management

We understand some members have special needs. In those cases, New Hampshire Healthy Families offers our members case management services to assist our members with special healthcare needs. If you have special healthcare needs, behavioral health needs, pregnant, or you have a disability, case management may be able to help you. Our case managers are registered nurses or social workers. They can help you understand major health problems and arrange care with your doctors. A case manager will work with you and your doctor to help you get the care you need.

This service is for members who have complex medical conditions. These members often see several doctors. They may need medical supplies or help at home.

Conditions may include:

 Sickle Cell

 Multiple Sclerosis

 Kidney or Renal Disease

 Organ Transplants

 HIV/AIDS

 Hemophilia

 Behavioral Health

Our case managers are nurses or social workers that can help members understand their health problems.

Our nurse works with the member and their doctors to help them get the care they need. The nurse can set up home health or other needed services. If you have special healthcare needs or you have a disability, case management may be able to help you. Our Member Services department can give you more information about Case Management Services. You can ask to speak to a case manager.

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Disease Management

New Hampshire Healthy Families has several programs to improve the health of our members. We know this means more than just helping you to see a doctor. It also means helping you find your way through the healthcare system so you get the treatments and the social services you need. It also means helping you understand and manage your health conditions. We do this through education and personal help from New Hampshire Healthy Families staff. The goal of this service is to add to the quality of your care and help you to improve your health. New Hampshire Healthy Families works with Nurtur to give disease management services to our members. Nurtur Health Coaches know a lot about conditions like:

 Asthma.  Diabetes.

 High blood pressure.  Heart problems.  Weight Management  COPD

All of our programs are geared toward helping you understand and actively manage your health. We are here to help you with things like:

 How to take medicines.  What screening tests to get.  When to call the doctor.

We will help you get the things you need. We will provide tools to help you learn and take control of your condition. For more information call Member Services at 1-866-769-3085. You can ask to speak to a Health Coach.

Preventive Care

New Hampshire Healthy Families recognizes the importance of good health. We offer preventive care services to help you and your family stay healthy. We encourage you to receive immunizations and health screenings to help lower your risk for chronic diseases. Health screening provides the opportunity for early detection and treatment with possibly better outcomes. It is important for you to visit your primary care provider or Medical

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Home for such preventive care services. We will work with you and your provider to ensure access to care. Below are some of the Preventive Care services provided.

Covered Preventive Care Services for Adults:

 Immunizations –vaccines for adults

 Behavioral, Depression screenings

 Well visits

 Disease Management including:

o Asthma

o Heart Disease

o Diabetes

o Obesity

Covered Preventive Care Services for Women include:

 Prenatal Care

 Educational and clinical services

 Start Smart For Your Baby

 Routine screenings and labs

 Well Women Visits

 Breast Cancer screenings

 Cervical Cancer screenings

Covered Preventive Care Services for Children may include:

 Autism screenings

 Behavioral screenings

 Congenital screenings

 Depression screenings

 Developmental screening

 Fluoride Varnishing – Oral health

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 Immunizations

 Risk Screenings

 Vision Care

CentAccount

®

Program

New Hampshire Healthy Families has a program to reward you for completing healthy behaviors. These healthy behaviors begin with a Health Risk Screening received in your Welcome Packet. New rewards will be added to your CentAccount card once you complete each healthy behavior. Your CentAccount card can be used for health-related products at stores which accept MasterCard® (such as Target, Wal-Mart, Walgreens, and local pharmacies). You can also use the card for health-related services at healthcare provider offices that accept MasterCard. Information on the CentAccount program can be found on our website at www.nhhealthyfamilies.com. Please call Member Services at 1-866-769-3085 for more information.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Health Check (EPSDT) is a preventive healthcare program for age birth to 21 years old. Children and young people need to see their doctor regularly even when they are not sick. This chart shows when babies, children and young adults need to see their doctor for a health check. We don’t want your child to miss any key steps toward good health as they grow.

Doctors and nurses will examine your child or teen. They will give shots for diseases when necessary. Shots are important to keep your child healthy. They will also ask questions about health problems and tell you what to do to stay healthy. If there is a problem found during the checkup, your doctor can send you to a specialist, or order any tests that might be needed, such as laboratory work, x-rays, etc.

Age Group Health Check Schedule

Infancy Birth

3 to 5 days By 1 month 2 months 4 months

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6 months

9 months

Early Childhood 12 months 15 months 18 months 24 months 30 months 3 years 4 years Middle Childhood &

Adolescence

Every year until age 21

To schedule a Health Check visit, call your doctor. If you have problems scheduling your visit, please call Member Services at 1-866-769-3085.

Family Planning Services

New Hampshire Healthy Families Health Plan covers family planning services. You can get these services and supplies from providers that are not in our network. You do not need a referral. These services are free for our members. These services are voluntary and confidential, even if you are less than 18 years old.

Some examples of family planning services are:

 Education and advice from a trained personnel to help you make choices

 Information about birth control

 Physical exams

 Follow-up visits

 Immunization services

 Pregnancy tests

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 Tests and treatment of STDs (sexually transmitted diseases)

When You Are Pregnant

Keep these points in mind if you are pregnant now or want to become pregnant:

 Go to the doctor as soon as you think you are pregnant. It is important for your health and your baby's health to see a doctor as early as possible. Seeing your doctor early will help your baby get off to a good start. It's even better to see your doctor before you get pregnant to get your body ready for pregnancy.

 Make an appointment with your dentist for a cleaning and checkup.

 Set a goal to live a healthier lifestyle. Healthy lifestyle habits include exercising, eating balanced healthy meals, and resting for 8-10 hours at night.

Pregnancy & Maternity Services

There are things you can do to have a safe pregnancy. See your doctor about any medical problems you have such as diabetes and high blood pressure. Do not use tobacco, alcohol, or non-prescribed drugs either now or while you are pregnant. New Hampshire Healthy Families recommends that you see your doctor before becoming pregnant if you have experienced any of the following problems:

 You have had three or more miscarriages.

 You have given birth to a premature baby (this means the baby came before 37 weeks of pregnancy), or a “preemie.”

 You gave birth to a stillborn baby.

A note about folic acid: Folic acid is a very important nutrient that can help you have a healthier baby. You should take folic acid before you become pregnant or as soon as you find out you are pregnant. Some foods that have folic acid in them include: orange juice, green vegetables, beans, peas, fortified breakfast cereals, enriched rice, and whole wheat bread. It is difficult to get enough folic acid from food alone. Ask your doctor about taking prenatal vitamins and see your doctor as soon as you think you are pregnant. If you have questions about folic acid or your pregnancy, call Member Services at 1-866-769-3085.