ICare Family Care Partnership (HMO D-SNP) 2020 Enrollment and Benefit Information
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The OTC benefit is even better for 2020
with our NEW prepaid benefits card!
OPEN NOW TO
LEARN MORE!
iCare Family Care Partnership (HMO D-SNP)
2020 Enrollment and Benefit Information
THERE IS ONLY ONE YOU!
iCare will support your choices to achieve your life goals.
iCARE FAMILY CARE PARTNERSHIP
This member booklet explains the iCare Family Partnership (FCP) program, its benefits,
added benefits, and services. It also explains who is eligible for the program and how to
enroll. Added benefits are on top of the regular benefits members get from Medicaid
and Medicare. Members do not need to give up the Medicaid and Medicare benefits they
already get.
A complete listing of iCare Family Care Partnership benefits and services are in the
Summary of Benefits or Evidence of Coverage.
We always want to help you.
The FCP Care Team or Customer Service can answer your questions.
We are open Monday – Friday, 8:30 a.m. – 5:00 p.m. Call us 24 hours a day, 7 days a week,
at 1-800-777-4376 (TTY: 1-800-947-3529).
WHAT IS iCARE FAMILY CARE PARTNERSHIP?
The iCare FCP program is a health and long-term care (LTC) program that fully integrates
all aspects of health care for frail older adults and adults who have physical, intellectual or
developmental disabilities.
Member benefits include health (primary and acute care), prescription drugs and LTC services
(personal, home and community-based services).
To be eligible for iCare FCP, you:
»» Must live in Dane, Kenosha, Milwaukee, Racine, or Sauk Counties
»» Have a physical/developmental disability (18 years of age or older)
»» Be a frail elderly adult 65 years of age or older
»» Must be eligible for Medicaid
»» Must have LTC service needs as determined by the State of Wisconsin
LTC Functional Screen
»» Must not have End Stage Renal Disease (exceptions apply)
BENEFITS & SERVICES
The following are examples of services provided through the iCare FCP program:
»» Home health and personal care »» Adult day and respite care
»» Support home care »» Home delivered meals
»» Assisted living/residential care services »» Home modifications
2 | 2020 iCare FCP Enrollment and Benefit Information
»» Transportation »» Drug and alcohol treatment
»» Physical, speech and occupational therapy »» Daily living skills training
»» Wheelchairs and other equipment »» Communication aids/interpreter
»» Adult diapers and gloves »» Employment services
»» Mental health treatment »» Nursing home services
PREVENTION AND EARLY INTERVENTION
The iCare FCP program helps members stay healthy and independent by working with public
and private health and social service partners in the community. We also provide information
and intervention activities that prevent the risk of disability.
SELF-DIRECT MY SUPPORTS
iCare FCP members have the option to choose Self-Directed Supports (SDS) as a way of
receiving some long-term care services. Choosing SDS means making your own decisions
about how and from whom you receive your long-term care services. You take the lead
in managing your care, having control over resources, including finances; and taking
responsibility for personal decisions and actions. Your Care Team can tell you more about
SDS if you are interested in this option.
TALK TO A NURSE — ALL DAY, EVERY DAY
iCare FCP members can call the Nurse Advice Line at 1-800-679-9874 to speak to a nurse.
The nurse can answer your questions about your health — about your body and about your
mental health.
PHARMACY ASSISTANCE
iCare has a fully-staffed pharmacy department, who can assist members with pharmacy
referrals, help them understand medications so it is taken correctly, answer questions, and
more! Call us on our Pharmacy Services Helpline at 1-866-938-0406.
2020 iCare FCP Enrollment and Benefit Information | 3
ADDITIONAL VISION BENEFITS Additional Vision (Eye) Benefit As an iCare Family Care Partnership plan member, you receive $450 towards the purchase of: »» Contact fitting (New for 2020!) »» Contact lenses (New for 2020!) »» One (1) set of eyeglass lenses and frames The benefit is per calendar year and cannot be combined with your Medicaid benefit. To use this benefit, you must see a provider who is in the iCare network. You also get your regular vision benefits provided by Medicaid and Medicare. You may have coverage from other sources, like your Medicaid benefit or another third-party payor. For more details about your vision benefits, please ask your Care Team, or read the 2020 Summary of Benefits or Evidence of Coverage. 4 | 2020 iCare FCP Enrollment and Benefit Information
ADDITIONAL DENTAL BENEFITS
Receive up to $2,500 a calendar year* to use on the following services:
PREVENTIVE DENTAL
»» Oral exams: Up to 2 per calendar year
»» Prophylaxis (Cleaning): Up to 2 per calendar year
»» Dental X-Rays: Up to 1 per calendar year
»» X-Rays are limited to either 1 panoramic or 1 full set per calendar year
COMPREHENSIVE DENTAL
»» Diagnostic Services: Up to 2 visits per calendar year
»» Simple Restorative Services, Limited to Amalgams/Resins (No root canals/crowns):
One restoration per tooth per calendar year
»» Extractions: Simple extractions only, no surgical extractions
»» Prosthodontics: Basic Partials and Basic Dentures are covered, no coverage for repair
»» Emergency Dental Office Visits: You may go as needed, but iCare will only pay for two (2)
visits per calendar year. You may have coverage from other sources, like your Medicaid
benefit or another third-party payor that may allow more covered emergency dental
visits. For more details about dental benefits, please ask your Care Team, or read the 2020
Summary of Benefits or Evidence of Coverage.
*Must use in-network providers.
2020 iCare FCP Enrollment and Benefit Information | 5
TELEHEALTH
If you have a computer at home, which uses a cable and not a phone to connect to the
internet, or a phone that has a camera and speaker, you can see and talk to a doctor or
nurse.
This is an additional benefit and does not cost iCare FCP members money. Up to 24 visits
(annually) are included for iCare FCP members. Visits are limited to: Behavioral Health
Providers, Nutritionists and Urgent Care Providers.
»» Behavioral Health: You can see and speak with a behavioral health provider for
conditions like depression, anxiety, stress, relationships, or insomnia (difficulty
sleeping).
»» Nutritionist: You can see and speak to a doctor or nurse that helps people to eat
healthy.
»» Urgent Care: You can see and speak with a doctor or nurse and talk about: colds, the
flu, if you have a fever (high body temperature), rash, stomach pain, and more.
Members can access this service by contacting their Care Team who will send the codes
that can be used to get these services.
6 | 2020 iCare FCP Enrollment and Benefit Information
SILVERSNEAKERS® At-home kits are offered for members
SilverSneakers is more than a fitness program. who want to start working out at home
It gives you the opportunity to connect with or for those who can’t get to a fitness
your community, make friends and stay active. location due to injury, illness, or being
The best part? SilverSneakers is included in this homebound. Currently, the following
plan at no additional cost. four at home kits are available: walking,
toning kit, strength and yoga.
»» FITNESS MEMBERSHIPS: Thousands of
popular locations – no need to pick just one. Please note: The type of kits are subject
to change.
»» CLASSES: Classes for all levels and abilities
led by instructors who specialize in senior WALKING TONING KIT
fitness.
»» ONLINE RESOURCES: Fitness location
directory, health and nutrition tips, and
SilverSneakers On-DemandTM video workouts
at SilverSneakers.com.
SilverSneakers mailed you a membership
ID card when you joined iCare Family Care
Pedometer to SilverSneakers®
Partnership. You need this card in order to use
track daily steps. exercise ball.
the exercise equipment or attend a class at a
SilverSneakers location. If you did not receive
the ID card or misplaced it and need a new STRENGTH YOGA
one, please call your Care Manager. If you do
not know your Care Manager’s name or direct
phone number, please call iCare Customer
Service at 1-800-777-4376 (TTY: 711).
If you have questions regarding your
SilverSneakers membership, call
1-888-423-4632 (TTY: 711), Monday – Friday,
Resistance band A yoga strap.
8:00 a.m. – 5:00 p.m., ET.
and over-the-door
attachment.
Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional
classes. Classes vary by location. Participating locations (“PL”) are not owned or operated by Tivity Health, Inc. or its
affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and
amenities vary by PL. Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of
Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. ©2019 Tivity Health, Inc. All
rights reserved.
2020 iCare FCP Enrollment and Benefit Information | 7
NEW AND IMPROVED OTC PROGRAM FOR 2020!
iCare Family Care Partnership members can get up to $180 a year to spend on products like
allergy/cold/sinus products, pain relief, dental and oral health products, first aid, ear and eye
care, and more!
Each month iCare will deposit $15 into an account that is linked to a prepaid benefits card so
you can purchase over-the-counter (OTC) items.
HOW THE PROGRAM WORKS
You will get a prepaid benefits card in the mail. The card will be activated. And your first
month’s OTC dollar amount of $15 will be loaded onto the card.
NOTE: It is important to keep the benefits card in your wallet, purse, bag — anywhere which
is a safe place for you because you will use the same card as long as you are an iCare Family
Care Partnership plan member.
You can choose where and how you want to purchase your OTC items:
»» NEW FOR 2020: Purchase OTC items in a participating retail store or pharmacy.
»» Or if making a trip to the store is hard, you can use the OTC product catalog and place an
order using your ID card by calling DrugSource, or order on DrugSource’s website.
PURCHASING ITEMS IN A RETAIL STORE OR PHARMACY
You can use your OTC prepaid benefits card to purchase approved or covered OTC items
only in a retail store. You cannot use your card on a retail store’s website. (You can, however,
purchase from DrugSource’s website.) To locate additional retailers and/or look-up items
available to purchase, visit www.otcnetwork.com.
8 | 2020 iCare FCP Enrollment and Benefit Information
You can make as many purchases as you want up to $15 a month or with your available
balance. Please note: Every retail store and/or pharmacy has their own return policy. Be sure
to check the return policy at the store(s) you shop at prior to purchasing products. A few of
the retail stores or pharmacies you can make purchases at are listed below:
How it works:
1. Take your activated OTC prepaid benefits card with you to a participating store.
2. Select the approved items you want to purchase then proceed to the store checkout lanes.
3. When you are making a purchase, you can give your prepaid benefits card to the person
at the register. You do not need a prescription and do not need to go to the pharmacy
window.
You can also swipe the card using the debit/credit card swipe machine for payment, if
it is available. Purchases of approved items are automatically deducted from your card
balance.
Remember you have $15 (or your available balance) to spend each month. If you don’t
use the entire $15, the remaining money will carry over to the next month. The remaining
balance reverts to iCare at the end of the year OR if you disenroll.
4. The payment will automatically be made from your account as long as you have enough
money in the account. Always keep your receipts of purchases and payments for your
records and to track the amounts you spent.
PURCHASING ITEMS USING THE OTC CATALOG
DrugSource is iCare’s preferred vendor for catalog purchases. Members can purchase
lower-cost generics or familiar brand-name products. The OTC benefit lets you make the
choice!
Members will receive a catalog in their new member packet. Look over the list of eligible items
available to purchase. Then organize your order by using the forms in the back of the catalog.
These forms were created to make it easy for you to place your order over the phone. Be sure
to write your Plan ID number on the form or have your ID card handy.
NOTE: Due to the personal nature of these products, returns are not accepted.
You are only allowed one purchase every month (up to $15 a month or your available
balance), but you can order as many items as you wish on that transaction.
2020 iCare FCP Enrollment and Benefit Information | 9
When you are ready to place your order you can do so by calling or visiting the website:
»» 1-877-319-9667 (TTY: 1-800-526-0844), Monday – Friday, 8:30 a.m. – 10:00 p.m.
»» https://shopping.drugsourceinc.com/icarefcpartner/
Items will be shipped to your home FREE of charge.
WHAT YOU NEED TO KNOW ABOUT YOUR OTC ACCOUNT
»» iCare will not cover additional types or classes of products not belonging to the categories on
the Centers for Medicaid and Medicare Services OTC list.
»» OTC items may be purchased for the use of iCare Family Care Partnership plan member’s
use only. You can’t purchase items for friends or family members. This benefit is ONLY for
you — the iCare Family Care Partnership plan member.
»» Some items, under certain circumstances, may be covered under either your Part B or Part D
benefits. When you receive these items under Part B or Part D, you may not purchase these
items through your OTC benefit.
CHECKING YOUR BALANCE
You can check the balance on your prepaid benefits card at any time by:
»» Calling 1-888-682-2400. You will be asked to enter your OTC card number. The number is
also on the back of your card.
»» Visiting the online member portal at www.otcnetwork.com. Once on the site, you will be
asked to enter your OTC card number.
»» Calling Customer Service at 1-800-777-4376 (TTY: 711) or the Pharmacy Services Helpline at
1-866-938-0406 (TTY: 711).
REPLACING YOUR OTC CARD
If you happen to lose your benefits card or it gets stolen, call iCare Customer Service at
1-800-777-4376 (TTY: 711). A replacement card will be mailed to the member within 7-10
business days.
10 | 2020 iCare FCP Enrollment and Benefit InformationCARE MANAGEMENT
You have people in the iCare FCP program that will help take care of you. They can help you
with your medical (body) health. They can help you with behavioral (brain) health.
They can also help connect you to additional resources called social services. Social services
include health care, welfare and counseling. It can also help people meet their basic needs
like food, water and shelter.
We want to help you. If you have questions about this service call us. If you have questions
about your other benefits call us.
Please call us and tell us how we can help you.
You can call your Care Team or Customer Service. Call 1-800-777-4376 (TTY: 1-800-947-3529).
You can call 24 hours a day, 7 days a week. Our office hours are Monday–Friday,
8:30 a.m. – 5:00 p.m.
We need to be able to contact you. If you move or change phone numbers call us and give
the new information.
2020 iCare FCP Enrollment and Benefit Information | 11WEIGHT MANAGEMENT NON-EMERGENCY
WW (formally Weight Watchers) is a company TRANSPORTATION
we work with to help you lose weight.
Would you like to attend a Weight
The program teaches what healthy foods Watchers class, but do not have a way
to eat. It will help you make good choices to get there? Transportation to/from a
and continue to make good choices. The Weight Watchers meeting is available to
program will support and help you to you. It is covered for 100 one-way trips up
exercise regularly. The teachers will come up to 35 miles to/from the class.
with fun, easy ways to get you moving. There
are many advantages to exercising. You will Please contact your iCare FCP Care
feel good. You will have more energy. And Team to learn more.
exercising reduces stress.
It’s hard to lose weight and eat healthier.
It’s always helpful to have support. You can
get support by going to meetings. At these
meetings, you will meet other people who
are trying to lose weight. There will also be
meeting leaders who can listen to you and
help motivate you to start losing weight. They
will help you keep positive thoughts.
You must get permission from iCare to go
meetings. One you get permission, you can
go to 13 meetings. After 13 meetings, you
must call iCare to get more tickets to visit
more meetings. The iCare FCP Care Team
issues the voucher packs. Members should
call 1-800-777-4376 (TTY: 1-800-947-3529).
12 | 2020 iCare FCP Enrollment and Benefit InformationPRESCRIPTION DRUG PROGRAM
iCare gives members comprehensive coverage for your prescription drug coverage (Part D).
But did you know your Part D coverage also includes the iCare Pharmacy Department support
and expertise to help ensure that the medication(s) you take are safe, effective, and delivered
conveniently? We think it’s the perfect mix to help keep you healthy and your costs low.
Our fully-staffed pharmacy department can assist with pharmacy referrals. You can reach
them by phone at 1-866-938-0406 (TTY: 711). They can help you:
»»Understand your medication(s) »»Find a pharmacy
»»Maximize your pharmacy benefit »»Have a better relationship with your
pharmacist
»»Perform medication reviews
»»Answer your questions
»»Save money on your prescriptions
And iCare Family Care Partnership members have the option to participate in the
90-Day Supply Program and Mail Order Program.
CONVENIENT, COST SAVING INSURANCE OPTIONS TO REFILL PRESCRIPTIONS
90-Day Supply Program Mail Order Program
Save time and money by taking advantage NoviXus, our mail-order pharmacy, can
of a 90-day supply of a prescription for a fill your prescription and deliver it to your
30-day co-pay. Tier 1 and Tier 2 Formulary home. Average delivery time is five (5) days,
medications only. and shipping is free!
This benefit is available at all To order your prescriptions by phone or to
in-network retail and mail-order inquire about an order,
pharmacies. call: 1-877-668-4987
Pharmacy Services Helpline: 1-866-938-0406
2020 iCare FCP Enrollment and Benefit Information | 13ATTENTION: If you speak English, language assistance services are
available to you free of charge. Call 1-800-777-4376 (TTY: 1-800-947-3529).
ATENCIÓN: Si habla español, los servicios de asistencia de idiomas están
disponibles sin cargo, llame al 1-800-777-4376 (TTY: 1-800-947-3529).
CEEB TOOM: Yog koj hais lus Hmoob, kev pab rau lwm yam lus muaj rau koj
dawb xwb. Hu 1-800-777-4376 (TTY: 1-800-947-3529).
注意： 如果您说中文，您可获得免费的语言协助服务。 请致电
1-800-777-4376 (TTY 文字电话: 1-800-947-3529).
DIGTOONI: Haddii aad ku hadasho afka Soomaaliha, adeegyada caawimada
luqadda waxaa laguu heli karaa iyagoo bilaash ah. Wac 1-800-777-4376
(TTY: 1-800-947-3529).
ໝາຍເຫດ: ຖ້າທ່ານເວົ້າພາສາລາວ, ທ່ານສາມາດໃຊ້ການບໍລກ ິ ານຊ່ວຍເຫຼືອ
ດ້ານພາສາໄດ້ໂດຍບໍ່ເສຍຄ່າ. ໂທ 1-800-777-4376 (TTY: 1-800-947-3529).
ВНИМАНИЕ: Если Вы говорите по-русски, Вам будут бесплатно
предоставлены услуги переводчика. Позвоните по номеру: 1-800-777-
4376 (TTY: 1-800-947-3529).
ေက်းဇူးျပဳ၍ နားဆင္ပါ - သင္သည္ ျမန္မာစကားေျပာသူျဖစ္ပါက၊
သင္အ ့ တြက္ အခမဲျ့ ဖင့္ ဘာသာစကားကူညေ ီ ရး ၀န္ေဆာင္မမ
ႈ ်ား
ရရွန
ိ ငုိ သ
္ ည္။ 1-800-777-4376 (TTY: 1-800-947-3529) တြင္
ဖုနး္ ေခၚဆိပ
ု ါ။
PAŽNJA: Ako govorite srpsko-hrvatski imate pravo na
besplatnu jezičnu pomoć. Nazovite 1-800-777-4376
(telefon za gluhe: 1-800-947-3529).
14 | 2020 iCare FCP Enrollment and Benefit Information اﺗﺻﻠوا ﺑﺎﻟرﻗم. ﺗﺗوﻓر ﻟﻛم ﻣﺳﺎﻋدة ﻟﻐوﯾﺔ ﻣﺟﺎﻧﯾﺔ، إذا ﻛﻧﺗم ﺗﺗﺣدﺛون اﻟﻌرﺑﯾﺔ:ﺗﻧﺑﯾﮫ
.(3529-947-8001- : )ھﺎﺗف ﻧﺻﻲ4376-777-8001-
Independent Care Health Plan:
• Provides free aids and services to people with disabilities to
communicate effectively with us, such as:
• Qualified sign language interpreters.
• Written information in other formats (large print, audio, accessible
electronic formats, other formats).
• Provides free language services to people whose primary language is
not English, such as:
• Qualified interpreters.
• Information written in other languages.
If you need these services, contact Independent Care Health Plan at
1-800-777-4376 (TTY: 1-800-947-3529).
Independent Care Health Plan (iCare), which insures iCare Family Care Partnership (HMO
D-SNP), is an HMO with a Medicare contract and a contract with the State Medicaid program.
Enrollment in iCare Family Care Partnership depends on iCare’s contract renewal.
This plan is available to anyone who has both medical assistance from the State and Medicare,
and is functionally eligible as determined by the State Long-Term Care Functional Screen. For
more information about long-term care options available to you contact the Aging & Disability
Resource Centers. The Resource Center can also assist you with information about eligibility and
enrollment.
Questions? Call 1-800-777-4376 (TTY: 711) for more information.
Independent Care Health Plan complies with applicable Federal civil rights laws and does not
discriminate on the basis of race, color, national origin, age, disability, gender identity, or sex.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al 1-800-777-4376 (TTY: 1-800-947-3529).
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau
1-800-777-4376 (TTY: 1-800-947-3529).
2020 iCare FCP Enrollment and Benefit Information | 151555 North RiverCenter Drive, Suite 206
Milwaukee, Wisconsin 53212
Phone: 1-800-777-4376
TTY: 1-800-947-3529
Fax: 414-272-5616
www.iCareHealthPlan.org
H2237_IC2293_M 10/27/2019
DHS Approved 10/23/2019
HOW DO I SIGN UP?
Contact the Aging & Disability Resource Centers (ADRC) in your county to assist you in
reviewing your options and enrolling in the iCare Family Care Partnership program.
Membership is voluntary and you can disenroll at any time.
Local: 608-240-7400 | Toll-free: 1-855-417-6892
Dane County
TTY: 608-240-7404
Local: 262-605-6646 | Toll-free: 1-800-472-8008
Kenosha County
TTY: 262-605-6663
»» For people 60 years of age or over call:
Local: 414-289-6874 | Toll-free: 1-866-229-9695
Milwaukee County TTY/TDD: 414-289-8591
»» For people under 60 years of age call:
Local: 414-289-6660
TTY/TDD: 414-289-8559
Local: 262-833-8777 | Toll-free: 1-866-219-1043
Racine County
TTY/TDD: 711
Toll-free: 1-877-794-2372
Sauk County
TTY/TDD: 711You can also read
