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Table of Contents

Important Telephone Numbers     2
Atlantis Health Plan     3
Atlantis Health Plan Identification Card     3
The Primary Care Provider     4
Changing Your Primary Care Provider     5
Specialty Services     5
Specialist as Primary Care Physician PCP     5
Second Opinions     6
Referrals     6
Standing Referrals to Atlantis Health Plan Specialist     6-7
Referrals to Atlantis Health Plan Specialty Care Centers     7
Changing Your Specialist     7
Out-of-Network Specialist Care and Specialty Centers     7-8
Transitional Care     9
Hospital Services     9
Urgent Care After Hours     10
Emergency Care     10-12
Routine Gynecological Care     12
Obstetrical/Maternity Care     12
Hospice     12
Behavioral Health Care Services     12-13
Prescription Drugs     13
Vision Care     13
Chiropractic Care     13
Experimental and/or Investigational Treatment/Procedures     14
Informed Consent and Advance Directives     14-15
Submitting Claims     15-16
Covered Services     16
Copayments     16-17
Excluded Services     17
Pre-authorization     17
Utilization Review     17-18
Appeal Procedures     19-20
Internal Procedures     20-21
External Procedures     21-23
Member Rights and Responsibilities     23-24
Member Services Department     25
The Grievance Process External Procedures     25-27
Membership Issues     27
Member Eligibility     27
Enrollment     27-28
Enrollment Changes     28
Benefit Coverage     28
Coordination of Benefits for Group Members     28-29
Termination of Coverage     29
Continuation of Group Coverage     29
Conversion to Individual Membership     30
Member Acknowledgments     30
Non-English Speaking Members     30
Medical Information and Records     30
Governing Agreement     30
Independent Contractors     30