Thank you for being a valued Molina member!
Here are some reminders and helpful information:
We are here to help you with your health care needs. If you have questions about your benefits or want to change your Primary Care Provider, call Member Services at (855) 882-3901, TTY/TDD: 711 from 8 a.m. to 6 p.m. Monday through Friday.
Member Handbook and Provider Directory:
- Your Member Handbook tells you about your health plan. You can find out more about your benefits and what is covered. To view or print a copy of your Member Handbook click HERE.
- Your Provider Directory can help you find a doctor. To view of print a copy of your Provider Directory click HERE.
If you would like a printed copy of the Member Handbook or Provider Directory or if you need a material in a different format such as braille or large print call Member Services.
Well-Child Doctor Visits:
Molina covers well-child doctor visits at no cost to members from birth through the month of their 21st birthday. These checkups make sure your children are growing and getting the health care they need.
These checkups include health, vision, dental and a hearing exam. Children also get immunizations (shots) and any lab tests needed. Parents and older children will receive health education.
It is very important that you get your child in for these checkups. Your child may look and feel well but still have a health problem. Your doctor can help find health concerns before they become bigger problems.
You can find a detailed well-child checkup schedule in your Member Handbook.
Our organization wants you to know that Molina adheres to the following:
- Utilization management decision making is based only on appropriateness of care and service and existence of coverage.
- The organization does not reward practitioners or other individuals for issuing denials of coverage.
- Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization.
Your Membership Rights:
Each Medicaid Managed Care Organization (MCO) member is guaranteed the following rights:
- To receive information about your member rights and responsibilities;
- To make recommendations to Molina Healthcare of South Carolina about these member rightsand responsibilities;
- To be treated with respect and with due consideration for your dignity and privacy;
- To participate in decisions regarding your health care, including the right to refuse treatment;
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in the federal regulations on the use of restraints and seclusion;
- To be able to request and receive a copy of your medical records, and request that they be amended or corrected;
- To receive health care services that are accessible, are comparable in amount, duration, and scope to those provided under Medicaid FFS, and are sufficient in amount, duration, and scope to reasonably be expected to achieve the purpose for which the services are furnished;
- To have a candid discussion of appropriate or medically necessary treatment options for your condition regardless of cost or benefit coverage;
- To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition;
- To receive all information, including but not limited to, enrollment notices, informational materials, instructional materials, available treatment options, and alternatives in a manner and format that may be easily understood;
- To receive assistance from both SCDHHS and Molina Healthcare of South Carolina in understanding the requirements and benefits of the Molina Healthcare of South Carolina’s plan;
- To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent;
- To be notified that oral interpretation is available and how to access those services;
- As a potential member, to receive information about the basic features of managed care, which populations may or may not enroll in the program and the MCO’s responsibilities for coordination of care in a timely manner in order to make an informed choice;
- To receive information on Molina Healthcare of South Carolina’s services, to include, but not limited to:
- Benefits covered;
- Cost-sharing requirements;
- Procedures for obtaining benefits, including any authorization requirements;
- Service area;
- Names, locations, telephone numbers of non-English language spoken by current contracted providers, including at a minimum, primary care physicians, specialists, and hospitals;
- Any restrictions on member’s freedom of choice among network providers;
- Providers not accepting new patients; and
- Benefits not offered by Molina Healthcare of South Carolina but available to members and how to obtain those benefits, including how transportation is provided.
- To receive a complete description of disenrollment rights at least annually;
- To receive notice of any significant changes in the Benefits Package at least thirty (30) days before the intended effective date of the change;
- To receive information on the Appeal, Grievance, and State Fair Hearing procedures including the right to file;
- To be able to file an appeal, a grievance (complaint) or request a State Fair Hearing;
- To receive detailed information on emergency and after-hours coverage, to include, but not limited to:
- What constitutes an emergency medical condition, emergency services, and Post Stabilization services;
- Emergency services do not require Prior Approval;
- The process and procedures for obtaining emergency services;
- The locations of any emergency settings and other locations at which providers and hospitals provide;
- Emergency services and Post Stabilization services covered under the contract. Your right to use any hospital or other setting for emergency care; and
- Post Stabilization care services.
- To receive Molina Healthcare of South Carolina’s policy on referrals for specialty care and other benefits not provided by your primary care provider;
- To have your privacy protected in accordance with the privacy requirements in the Code of Federal Regulations (45 CFR, 160, 164 (A)(E)), to the extent that they are applicable; and
- To exercise these rights without adversely affecting the way Molina Healthcare of South Carolina, its providers, or SCDHHS treats the members.
Member Value Add Benefits:
Molina members can get what’s covered under the Healthy Connections program and more. Click HERE to see some of the extra benefits that are available to eligible Molina members at no cost.