With Neighborhood INTEGRITY, you get all the benefits you are receiving from Medicare, Medicare Part D, and Rhode Island Medicaid through one plan. Certain Medicaid benefits will still be covered through Rhode Island Medicaid (ex. non-emergency transportation services). We can help you access those services.
For a full list of benefits, please see your Member Handbook on the Member Materials page for a complete listing of covered services, exclusions, and prior authorization rules.
| Medical Benefits | Member Copay |
| Hospitalization – medical* and behavioral health | $0 |
| Skilled Nursing Facility – 3 day hospitalization stay not required* | $0 |
| Emergency Care in the US and its territories | $0 |
| Provider visits | $0 |
| Annual Physical | $0 |
| Urgent Care in the US and its territories | $0 |
| MRI, CT Scans, Labs** | $0 |
| Durable Medical Equipment** | $0 |
| Outpatient Behavioral Health Services** | $0 |
| Medicare Part B Drugs* | $0 |
| Preventive Services | $0 |
| Adult Day Health Programs** | $0 |
| Respite Services | $0 |
| Homemaker services* | $0 |
| Physical Therapy Evaluation & Services** | $0 |
| Environmental Modification, e.g. shower chair* | $0 |
| Part D and Over the Counter Drugs (Retail & Mail Order)** | $0 |
*Prior authorization rules apply
**Prior authorization rules may apply
Non-emergency medical transportation will be provided through Medical Transportation Management, Inc.
Behavioral Health and Substance Use Treatment Services
Neighborhood INTEGRITY benefits include behavioral health and substance use services. Covered benefits have a $0 copay, coinsurance; or deductible.
These services are managed by our partner Optum®. Our shared goal is to assist you in being as healthy as you can be, both mentally and physically. We cover both inpatient* and outpatient mental health and substance abuse programs designed to help diagnose and treat your condition.
Services include:
- Day treatment
- Intensive outpatient services*
- Substance abuse residential treatment*
- Methadone maintenance*
- Integrated Health Homes (IHH)*
- Mental Health Psychiatric Rehabilitation Residence (MHPRR)*
- Assertive Community Treatment (ACT)*
- Psychiatric rehabilitation day programs*
- Opioid Treatment Program (OTP)*
- Partial Hospitalization*
Please contact Optum® directly at 1-401-443-5995 (TTY 711) for more information on these services.
*OON services prior authorization rules apply
Long-Term Services and Supports (LTSS)
If eligible for Long-Term Services and Supports***, Neighborhood INTEGRITY provides coverage for:
- Skilled nursing services**
- Meals on Wheels
- Assisted Living Facility*
- RIte@Home shared living
- Nursing Home Care*
You may also be interested in the Personal Choice program. This program allows you to be your own boss in hiring personal care assistants* and paying for the services that will help you to stay at home or in the community.
*Prior authorization rules apply
**Prior authorization rules may apply
Extra Benefits and Services
Routine Dental Service – Coverage includes preventive & restorative services such as: cleanings, oral exams, fluoride treatment, X-rays, and more. This benefit has a maximum limit of $1,250 per calendar year.
In-Home Support Services – Coverage includes up to 120 hours per year of companion care to assist with everyday tasks.
Healthy Food and Nutrition Benefit – Coverage includes a healthy food and savings card with a $75 monthly allowance that can be used to purchase healthy and nutritious groceries.
Fitness benefit – Coverage includes access to a contracted fitness facility. Fitness benefit includes a health and gym membership with an activity tracker.
Home Delivered Meals after inpatient hospitalization or surgery – Coverage includes home-delivered meals after discharge from an inpatient hospitalization or surgery. This benefit covers fourteen (14) meals for two weeks and limited to twice (2) per year for a total of twenty-eight (28) meals is covered.
No Authorization is required for supplemental benefits.
Please refer to Member Handbook for a complete listing of services.
***Note: Members receiving Long Term Services and Supports (LTSS) may have a patient share responsibility. Please contact the Department of Human Services (DHS) Long Term Care Office (LTC) for more information on whether patient share applies to you.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Neighborhood INTEGRITY Member Handbook.
| Medical Benefits | Member Copay |
| Hospitalization – medical and behavioral health* | $0 |
| Skilled Nursing Facility – 3 day hospitalization stay not required* | $0 |
| Emergency Care in the US and its territories | $0 |
| Provider visits | $0 |
| Annual Physical | $0 |
| Urgent Care in the US and its territories | $0 |
| MRI, CT Scans, Labs** | $0 |
| Durable Medical Equipment** | $0 |
| Outpatient Behavioral Health Services** | $0 |
| Medicare Part B Drugs* | $0 |
| Preventive Services | $0 |
| Adult Day Health Programs** | $0 |
| Respite Services | $0 |
| Homemaker services* | $0 |
| Physical Therapy Evaluation & Services** | $0 |
| Environmental Modification, e.g. shower chair** | $0 |
| Part D and Over the Counter Drugs (Retail & Mail Order)** | $0 |
*Prior authorization rules apply
**Prior authorization rules may apply
Non-emergency medical transportation will be provided through Medical Transportation Management, Inc.
Behavioral Health and Substance Use Treatment Services
Neighborhood INTEGRITY benefits include behavioral health and substance use services. Covered benefits have a $0 copay, coinsurance; or deductible.
These services are managed by our partner Optum®. Our shared goal is to assist you in being as healthy as you can be, both mentally and physically. We cover both inpatient* and outpatient mental health and substance abuse programs designed to help diagnose and treat your condition.
Services include:
- Day treatment**
- Intensive outpatient services**
- Substance abuse residential treatment*
- Methadone maintenance
- Integrated Health Homes (IHH)**
- Mental Health Psychiatric Rehabilitation Residence (MHPRR)**
- Assertive Community Treatment (ACT)**
- Psychiatric rehabilitation day programs**
- Opioid Treatment Program (OTP)**
- Partial Hospitalization*
Please contact Optum® directly at 1-401-443-5995 (TTY 711) for more information on these services.
*Prior authorization rules apply
**Prior authorization rules may apply
Long-Term Services and Supports (LTSS)
If eligible for Long-Term Services and Supports***, Neighborhood INTEGRITY provides coverage for:
- Skilled nursing services**
- Meals on Wheels
- Assisted Living Facility*
- RIte@Home shared living
- Nursing Home Care*
You may also be interested in the Personal Choice program. This program allows you to be your own boss in hiring personal care assistants* and paying for the services that will help you to stay at home or in the community.
*Prior authorization rules apply
**Prior authorization rules may apply
Extra Benefits and Services
Routine Dental Service – Coverage includes preventive services such as: cleanings, oral exams, fluoride treatment , X-rays, and more. This benefit has a maximum limit of $1,000 per calendar year.
In-Home Support Services – Coverage includes up to 120 hours per year of companion care to assist with everyday tasks.
Healthy Food and Nutrition Benefit – Coverage includes a healthy food and savings card with a $35 monthly allowance that can be used to purchase healthy and nutritious groceries.
Fitness benefit – Coverage includes access to a contracted fitness facility. Fitness benefit includes a health and gym membership with an activity tracker.
Home Delivered Meals after inpatient hospitalization or surgery – Coverage includes home-delivered meals after discharge from an inpatient hospitalization or surgery. This benefit covers fourteen (14) meals for two weeks and limited to twice (2) per year for a total of twenty-eight (28) meals is covered.
No Authorization is required for supplemental benefits.
Please refer to Member Handbook for a complete listing of services.
***Note: Members receiving Long Term Services and Supports (LTSS) may have a patient share responsibility. Please contact the Department of Human Services (DHS) Long Term Care Office (LTC) for more information on whether patient share applies to you.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.
Questions?
Please call us at 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday, 8 a.m. to 12 p.m. on Saturday. On Saturday afternoons Sundays, and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.
Neighborhood INTEGRITY (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.
Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al 1-844-812-6896 (TTY 711). Alguien que hable español le podrá ayudar. Este es un servicio gratuito.
Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número 1-844-812-6896 (TTY 711). Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito.
យើងមានសេវាអ្នកបកប្រែផ្ទាល់មាត់ដើម្បីឆ្លើយរាល់សំណួរដែលអ្នកអាចមានអំពីគម្រោងសុខភាព និងថ្នាំរបស់យើងខ្ញុំ។ ដើម្បីទទួលបានអ្នកបកប្រែផ្ទាល់មាត់ គ្រាន់តែហៅទូរសព្ទមកយើងខ្ញុំតាមរយៈលេខ 1-844-812-6896 (TTY 711)។ អ្នកដែលនិយាយខ្មែរជួយអ្នកបាន។ នេះជាសេវាកម្មឥតគិតថ្លៃ។
Our plan can also give you materials in Spanish, Portuguese, and Khmer in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.
Last updated: November 15, 2024 @ 10:30 am
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