TABLA DE CONTENIDOS. Primary and Specialist Providers Fees / Precios de los servicios medicos primarios y especialistas...20

Tamaño: px
Comenzar la demostración a partir de la página:

Download "TABLA DE CONTENIDOS. Primary and Specialist Providers Fees / Precios de los servicios medicos primarios y especialistas...20"

Transcripción

1

2

3 TABLA DE CONTENIDOS Membership Agreement / Acuerdo de Membrecia...7 Welcome Letter / Carta de Bienvenida...8 Terms and Conditions / Términos y Condiciones...9 How to Use Your Card? / Cómo usar su tarjeta?...10 Primary and Specialist Physicians / Medicos Primarios y Especialistas...11 Primary Physicians Locations / Direcciones de los Medicos Primarios...12 Gynecology & Obstetrics / Ginecologia y Obstetricia...17 Pediatrics / Pediatria...18 Primary and Specialist Providers Fees / Precios de los servicios medicos primarios y especialistas...20 Medical Centers / Centros Medicos...21 Specialist Physicians Locations / Direcciones de los Medicos Especialistas...25 Neurological Studies Fees / Precios de los estudios neurologicos...30 Urgent Care Centers / Centros de Cuidados de Urgencia...35 Dental Services / Servicios Dentales...37 General Dentistry Fees / Precios de los servicios de Odontologia General...38 Dental Specialties Fees / Precios de los Servicios Dentales por Especialidad...43 Optical Services / Servicios Opticos...44 Optical Sevices Fees / Precios de los Servicios Opticos...47 Clinical Laboratories / Laboratorios Clinicos...48 Laboratories Locations / Direcciones de los Laboratorios...49 Laboratory Services Fees / Precios de los Servicios de Laboratorio...50 Diagnostic and Radiology Centers / Centros de Diagnostico y Radiologia...58 Diagnostic Centers Locations / Direcciones de los Centros de Diagnostico...58 Diagnostic Services Fees / Precios de los Servicios de Diagnostico...61 Ancillary Services / Servicios Auxiliares...66 Durable Medical Supplies / Equipos Medicos Duraderos...66 Orthopedic Supplies/ Suplementos Ortopedicos...67 Hearing Aids/ Suplementos Auditivos...68 Transportation/ Transportacion...69 Home Health and Physical Therapy / Servicios a domicilio y Terapia Fisica...70 Diabetes Supply Services / Suplementos para la Diabetes...72 Pharmacy Services / Servicios Farmaceuticos...73 Pharmacy Locations / Direcciones de las Farmacias...74 Pharmacy Services Fees / Precios de los Servicios de Farmacia...77 Cosmetology Services Fees / Precios de los Servicios de Cosmetologia...82

4 Disclaimer of Liability In consideration of the monthly payment fees to be paid to Med Plan by you or on your behalf, Med Plan agrees to arrange for the delivery of health care services in accordance with and subject to the terms of the Agreement entered into between you or on your behalf, and Med Plan. Med Plan, in so arranging for the delivery of health care services and supplies, does not directly provide these services nor supply them. Rather, Independent Contractors provide these services and supplies. The health care providers listed in this directory are not employees or agents of MedPlan. MedPlan shall not be liable for any negligent act or omission committed by any of the providers listed in this directory, or any of their employees or agents who may, from time to time provide medical services to you. MedPlan expressly disclaims any agency relationship, actual or implied, with any health care provider. MedPlan does not exercise any control or direction over the medical judgement or clinical decisions of any health care provider listed in this directory and does not interfere with the physician patient relationship between you and any health care provider. It is important for you to know when you enroll in MedPlan that the continued participation of any one doctor, hospital or other provider cannot be guaranteed. This directory is current as of date of publication. Some plan providers may have been added or removed from this list after this directory was printed. To get the most up-to-date information about MedPlan providers in your area, you can visit or call our Customer Service Department at , Monday through Friday, 9:00 am to 6:00 pm. The fact that a provider is listed does not guarantee that they are still in the network or accepting new patients. The Plan Providers listed in this directory have agreed to provide you with your health care coverage at fixed discounted from their usual and customary pricing rate. Members are limited to only those providers that are affiliated to the MedPlan Network of Providers. Participating physicians and other providers listed in this directory or on our website are not agents, employees or partners of MedPlan or any of its subsidiaries. MedPlan is not a medical services provider, a medical insurance plan nor an HMO. MedPlan does not control nor endorse the judgement or clinical treatment recommendations made by the physicians or other providers listed in our directory, or in our website nor those that you chose to select. All MedPlan providers are independent contractors. You may go to any of our plan providers listed in this directory; however some services may require a prescription or medical treatment plan provided by a licensed medical physician. If you have been going to one plan provider, you are not required to continue going to that same provider. Providers are independent. Providers are listed in this directory by the type of provider: Primary Care Physicians (PCP), Family Medicine, Specialists, Urgent Care Centers, Diagnostic Centers, Laboratory, Pharmacy, Optical, Dental, and Durable Medical Equipment providers. Within each provider type, providers are lsited by COUNTY. You can also visit or call Customer Care Department at Our providers are paid on a contracted discount fee-for-service basis by you at the time the service is rendered. If you use Non-Plan providers, understand that Non-Plan providers are not part of MedPlan network. In that case, you will have to pay the provider their usual and customary fees which are significantly higher than the contracted rate MedPlan has with its in-network providers. care or services you get from non-plan providers will NOT be covered. MedPlan services are limited to the counties that MedPlan has providers and services contracted in. Any services provided outside MedPlan service areas will not be at the contract price. You have the right to get timely access to plan providers and to all discounts covered by the plan. Timely access means that you can get appointments and services within a reasonable period of time. You have the right to get full information from your providers when you go for medical care. You have the right to participate fully in decisions about your healthcare. You have the right to refuse care. MedPlan does not limit its members from visiting any provider contracted by MedPlan. You can visit any provider or service without any limitation or need for referral. MedPlan does however recommend that the member choose a primary care physician from our directory to be the gate keeper or central coordinator for all referrals to specialist and services. 4

5 This insures that the member s service ordered or more importantly that the member is not prescribed medication that can be contraindicated to another medication ordered by an unknown provider. Also please note due to the nature of health care delivery systems it is sometimes necessary to have a written prescription or medical treatment plan in order to have services rendered by certain MedPlan providers. These services are Pharmacy, Durable Medical Equipment, Laboratory Services, Physical Therapy and Diagnostic Radiology services. Please visit your Primary Care Provider or Specialist to get the proper treatment orders before visiting any MedPlan support service providers listed above. Services such as Dental and Optical can be accessed directly by the member at anytime without providing notification to your PCP. Please note that any medical emergency should be directed to the nearest Urgent Care Center or local Hospital Emergency Room. The following directory is constantly changing and is therefore subject to change without notice. For current and update providers information please visit our website: Excepción de responsabilidad civil. MedPlan, en consideración al pago de su membrecía, está de acuerdo en ofrecerle el acceso a la red de proveedores establecida que prestan sus servicios a nuestros miembros. MedPlan coordinará su primera cita con el proveedor que usted elija dentro del directorio. MedPlan no asigna a ningún proveedor. Es responsabilidad del miembro elegir el médico que le prestará los servicios. MedPlan no ofrece los servicios médicos directamente, sino a través de proveedores independientes que proveen estos servicios y sus suplementos. Los proveedores que aparecen en este directorio no son empleados o agentes de MedPlan. Los empleados o agentes de MedPlan no deben ser responsables legalmente por alguna negligencia o acto de omisión cometida en cualquier momento por algún proveedor que aparezca en este directorio. MedPlan específicamente no se responsabiliza en ningún momento y no tiene ninguna relación de agencia con ningún proveedor médico. MedPlan no ejerce ningun control o dirección respecto a un criterio médico o decisión clínica de algún proveedor del directorio ni interfiere en la relación entre el paciente y su médico. Es importante que al convertirse en miembro de Med Plan, la persona sepa que no se le garantiza la continua participación de un doctor, hospital, u otro proveedor. Este directorio está vigente desde el día en que fue publicado. Es muy posible que a partir de ese dia se hayan agregado o eliminado de la lista algunos proveedores. Para obtener una información actualizada de los proveedores en su area, visítenos en o llame a nuestro Departamento de Servicio al Cliente, al , de Lunes a Viernes de 9:00 am a 6:00 pm. El hecho de que un proveedor se encuentre en la lista no garantiza que todavía se encuentre en la red o que participe consultando nuevos pacientes. Los proveedores listados en este directorio han acordado en proveerles a los miembros de Med Plan sus servicios de cuidado a su salud con una tarifa fija que representa un Ahorro sobre la tarifa regular. Usted puede ir a cualquiera de nuestros proveedores en este directorio y no necesita ser referido por el médico primario que le atiende para visitar a un especialista dentro de la red, pero algunos de estos servicios, como son los exámenes de laboratorio, radiología o diagnóstico sí requieren de una referencia por parte del doctor que le ordena el examen o procedimiento. Si usted ha ido a uno de nuestros proveedores y no se siente satisfecho con sus servicios, usted no está en la obligación de seguir visitándolo. Los miembros están limitados a los proveedores que están afiliados a la red de MedPlan. Los proveedores participantes en este directorio o en no son agentes, empleados o socios de MedPlan, ni ninguno de sus subsidios. MedPlan no es un proveedor de servicios médicos, ni tampoco un plan de seguros médicos ni un HMO. MedPlan no apoya los diagnósticos ni los tratamientos médicos dados por los proveedores participantes en la red de MedPlan listados en este directorio, ni en ni los proveedores escogidos por nuestros miembros. Los proveedores son independientes. Los proveedores en este directorio han sido clasificados según tipo de proveedor: Doctores primarios(pcp), Medicina familiar, Especialistas, Centros de cuidados de urgencia, Centros de terapia física, Centros de diagnóstico, Laboratorios, Cuidado médico en el hogar, Farmacias y Equipos médicos. Cada especialidad ha sido clasificada en sus respectivos condados. Visítenos en o llámenos al Departamento de atención al cliente al Nuestros proveedores tienen que ser pagados por usted a la hora de recibir sus servicios. MedPlan tiene varios tipos de acuerdos contractuales con los proveedores que son comunes en los planes médicos. Si usted usa un proveedor que no forma parte de la red de MedPlan, usted no recibirá la tarifa negociada y tendrá que pagar la tarifa completa que exija ese proveedor. Los descuentos de MedPlan no se aplican si usted viaja fuera de las areas de servicios. 5

6 Usted tiene derecho al acceso de la red de nuestros proveedores y a todos los descuentos disponibles en el plan. Esto significa que usted puede obtener citas y servicios en un tiempo razonable. Usted tiene derecho a recibir de su proveedor toda la información referente a su cuidado o tratamiento médico, a participar completamente en las decisiones sobre su salud, y al derecho de rehusar su tratamiento médico. MedPlan no limita a sus miembros a visitar a cualquier proveedor que pertenezca a su red. Usted puede visitar a cualquier proveedor o servicio sin ningún tipo de limitación o necesidad de derivación. MedPlan recomienda, sin embargo, que el miembro elija un médico de atención primaria de nuestro directorio para ser el coordinador central para todas las derivaciones al especialista y servicios. Esto asegura que los servicios de los miembros se coordinen y el miembro reciba la atención médica adecuada con el pleno conocimiento de su PCP. Esto evitará la duplicación de los servicios solicitados, o más importante aún, que al miembro no se le prescriba un medicamento que puede estar contraindicado con otro medicamento ordenado por un proveedor desconocido. Tambien tenga en cuenta que debido a la naturaleza de los sistemas de prestación de asistencia sanitaria, a veces es necesario tener una prestación escrita o plan de tratamiento médico a fin de que los servicios prestados por determinados proveedores de MedPlan estén prescritos correctamente. Estos servicios son Farmacia, Equipo médico duradero, Laboratorio, Radiología diagnóstica, Terapia física, etc. Visite a su proveedor de atención primaria o especialista para obtener las órdenes de un tratamiento adecuado antes de visitar cualquier proveedor de los antes mencionados. El siguiente directorio está sujeto a modificaciones constantes y puede cambiar sin previo aviso. Para más información actualizada visítenos en 6

7 MEMBERSHIP AGREEMENT MED PLAN LLC Attn: Compliance Department 7200 NW 7th ST, Suite 100 Miami, Fl For assistance and plan information call: or plan information, to change your method of payment, to add family members or for any other assistance please call the customer service number located on the back of your membership card. All documents contained herein (i.e. Terms and Conditions and Member Benefits) are hereby attached to and made a part of the Membership Agreement. Disclosures: 1. This plan is not a health insurance policy. 2. This plan provides discounts at certain health care providers for medical services. 3. This plan does not make payments directly to the providers of medical services. 4. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. Terms and Agrements: To terminate or cancel the member agreement please call the number above or send a written cancellation notice to the Discount Medical Plan Organization at the address provided above. This agreement can be cancelled for non-payment. If the discount medical plan organization cancels a membership for any reason other than nonpayment of fees by the member, the discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member. If you cancel for any reason within 30 days after the effective date, you will receive a full refund of paid membership fee, excluding the one-time application fee. Legal Notice: Med Plan is not an insurance company. Med Plan offers discounts on some health providers for their medical services. Med Plan does not make direct payments to the providers of medical services. The members of Med Plan are required to pay for all the health care services, but will have a discount on the health providers contracted. ACUERDO DE MEMBRECIA Para asistencia e información sobre el plan por favor llame al Para información del plan, para cambiar la forma de pago, para agregar miembros de la familia o cualquier otro tipo de asistencia llame al Departamento de Atencion al cliente situado en la parte superior de su tarjeta de membrecia: Todos los documentos incluidos (beneficios de los miembros, términos y condiciones de estos) se mostrará en estas páginas y forma parte del Acuerdo de Membrecía. Para cancelar su membrecía, por favor llame al número indicado anteriormente y envíe una notificacion con su puño y letra explicando los motivos de su cancelación al Departamento de Servicio al Cliente de MedPlan. Por favor envíe las tarjetas de membrecía de cada miembro junto con la carta de cancelación, esta carta debemos recibirla antes de los 30 días despues que se afilió a la Compañía. Este acuerdo puede ser cancelado por no pagar su mensualidad. Si el Departamento de Servicios al Cliente de MedPlan cancela su membrecía por cualquier razón que no sea el pago de su mensualidad MedPlan le hará el reembolso con la suma de los días no utilizados. Proceso de cancelación:si usted cancela su membrecía por cualquier razón dentro de los 30 días siguientes a la fecha de efectividad, usted recibirá un rembolso completo de su pago, excepto la cuota de inscripción de $ Aviso Legal Med Plan no es un seguro médico. Med Plan proporciona descuentos con los proveedores de la salud que han sido contratados. Med Plan no efectúa pagos directamente a los proveedores de los servicios médicos. Los miembros de Med Plan están obligados a pagar por todos los servicios Médicos, pero recibirán un descuento de los provedores de salud que han sido contratados. 7

8 WELCOME We are pleased to welcome you to Med Plans Premier Plus benefits program. You can enjoy savings on your health care needs by using your new membership card, which is enclosed in your new member packet. We help in caring for your health and your family. For your convenience we have enclosed with your membership kit a complete directory of all Med Plans contracted participating providers. Our Member Services Department is also available during business hours to assist you in locating additional providers in your area. Just call our toll-free number located on the back of you membership card, or you may go to the internet at at any time day or night. If your favorite provider is not already on our program, you may nominate them to Members Services for additional follow-up. Please keep in mind that your membership is NOT insurance, so it is simple and easy to use. You can begin using Med Plans complete list of services immediately as many times as needed without need of prior approvals. When you present your card with your ID to a participating provider you will have immediately access to the exclusive pricing Med Plan members receive at time of service. We also understand that your family s health is your number one priority, so all legal dependents you have enrolled as part of your plan will receive their own card that they need to take with them to access the same pricing and services. If for any reason you are not satisfied with this program or are having problems in accessing services, pleased call the number on the back of your card for prompt response to any issue. We encourage our new members to please take a moment to familiarize yourself with the instructions in this booklet so that you can better understand how Med Plan works and what is required to access the different services. Please remember the more informed you are, the better your experience with Med Plan will be and the more often you will take advantage of the tremendous serves and exclusive pricing that Med Plan offers you. Remember your Health is the most precious gift you have. Let Med Plan help protect it. BIENVENIDOS Nos complace darle la bienvenida a un programa de beneficios de primer nivel. Puede disfrutar de ahorros en sus necesidades de salud mediante el uso de su nueva tarjeta de membrecía, que se incluye en su paquete de nuevo miembro. Le ayudamos en el cuidado de su salud y la de su familia Para su comodidad, le proporcionamos una guía de proveedores contratados por Med Plan que incluyen, direcciones y números de teléfono. Nuestro Departamento de Servicios también está disponible durante horas de oficina para ayudarle a encontrar proveedores en su área y ayudarlos a conseguir una cita o usted puede visitar nuestro sitio Web: a cualquier hora del día o llamar al (305) en horas laborables. Si su Doctor favorito no pertenece a nuestra Red, usted puede llamar a Med Plan al Departamento de Relación con proveedores y nosotros lo vamos a contactar, haciendo todo lo posible por lograr que se una a nuestra Red y continúe brindándole los servicios que usted se merece a través de nuestro Plan Médico. Med Plan en ningún caso le garantiza el resultado de esta Gestión. Por favor, tenga en cuenta que su membrecía NO ES UN SEGURO MEDICO, por lo que es simple y fácil de usar. Usted puede usar la tarjeta inmediatamente y tantas veces como sea necesario. Al presentar su tarjeta a usted se le aplicará inmediatamente la tarifa de descuento en el momento de la compra o servicio. En Med Plan, sabemos que la salud de su familia es su prioridad. Todos los dependientes legales podrán utilizar su tarjeta de membrecía, o solicitar tarjetas adicionales en caso de pérdida para usted o algún miembro de la familia con su propio nombre sin costo alguno, simplemente llamando al Departamento de Servicios al cliente. Si por alguna razón usted no está satisfecho con este plan, llame al número en la parte posterior de su tarjeta para su reclamo. PORQUE SU SATISFACCION ESTA GARANTIZADA! 8

9 TERMS AND CONDITIONS 1. Primary member is defined as the person who is responsible for the monthly payments for membership fees and is of legal age. The primary member, spouse, and all legal dependents listed on the enrollment application can access the services and exclusive pricing at Med Plan Contracted service providers. 2. Participating provider may be added or removed from the respective network in which they are associated with. These changes are made in best interest of our members. Updated Provider information will be made availableonline at www:floridamedplan.com 3. Companies contracted to provide benefits and services in this program are not a licensed insurer, health maintenance organization (HMO), or any other underwriters of healthcare services. No portion of any provider fees will be reimbursed or otherwise paid. 4. The exclusive Med Plan pricing contained herein may not be used in conjunction with any other medical plan or discount program. All listed or quoted prices are current prices from participating providers and subject to change without notice. From time to time, certain providers may offer products and /or services to the general public at prices lower than the prices available through this program. In such event, members will be charged the lowest price. 5. Providers are subject to change without notice and programs may vary in some states. This is a discount membership program only, not insurance, and may be discounted or modified at anytime. 6. Savings are based upon the provider s normal fees. Actual savings will vary depending upon location and specific services or products purchased. 7. This discount medical plan does not warrant professional services, nor is it responsible for the quality of care received. This program makes no warranties expressed or implied concerning services or care provided by participating providers. 8. (30) Day Money Back Guarantee: If you cancel for any reason within 30 days, you will receive a full refund. Nonrefundable one time fees will be disclosed at time of application. 9. All applicable limitations, exclusions and exceptions of the discount medical plan benefits are listed with each benefit description. TERMINOS Y CONDICIONES 1. El titular es definido como miembro principal, el cónyuge y todos los dependientes legales adicionales contaran automáticamente con los mismos beneficios que se ofrecen en el plan. 2. En cualquier momento, un proveedor participante puede ser eliminado de la red en la que está asociado con el plan. 3. Las compañías proveedoras de beneficios y descuentos en este plan no son de seguro, suscriptor de servicios de salud. Ninguna organización de la salud (HMO), u otro parte de cualquier proveedor de los honorarios será reembolsado o pagado de otra manera. 4. Los descuentos que figuran en este documento no pueden ser utilizado en combinación con cualquier otro plan de descuento médico o programa de descuentos. Todos los precios cotizados son los precios actuales de los proveedores participantes y están sujetos a cambios sin previo aviso. De vez en vez, algun proveedor puede ofrecer productos y / o servicios al público en general a precios inferiores a los precios disponibles en este programa. En Tal caso, se cobrará el precio más bajo. 5. Los proveedores están sujetos a cambios sin previo aviso, los programas pueden variar en algunos términos. Este es un programa de membrecía de descuento, no un seguro medico, y puede ser cancelado o modificado en cualquier momento. 6. Los ahorros se basan en las tasas normales del proveedor. Los ahorros reales variarán dependiendo de la localización de los servicios específicos o productos comprados. 7. Med Plan no es un seguro médico. Med Plan proporciona descuentos con los proveedores de la salud que han sido contratados por servicios médicos. Med Plan no efectúa pagos directamente a los proveedores de servicios médicos. Los miembros de Med Plan están obligados a pagar por todos los servicios de la atención de la salud, pero recibirán un descuento de los proveedores contratados por Med Plan. 8. Los proveedores contratados por MED PLAN son los únicos responsables por el asesoramiento profesional y el tratamiento administrado a los miembros. MED PLAN no se responsabiliza por los servicios, tratamientos o procedimientos ofrecidos por los proveedores contratados. 9. Garantía de Reembolso por 30 Días: Si cancela por cual quier razón en el plazo de 30 días, usted recibirá un reembolso completo de su mensualidad. Tasa no reembolsable se revelará en el momento de aplicación. 10. Este plan de descuentos médicos no garantiza los servicios profesionales, ni es responsable de la calidad de la atención recibida. Este plan no ofrece ninguna garantía implícita relativa a los servicios o asistencia médica prestados por los proveedores participantes. 9

10 HOW TO USE YOUR MEMBERSHIP CARD 1. Keep your membership card with you at all times so it will be easily accessible to present at provider locations. Please note that you must present your membership card so that the status of you membership can be verified before services are provided and to qualify for Med Plan exclusive price at contracted provider locations. 2. When visiting your Physician and or Specialist you must present your Med Plan membership card with a picture ID so that your eligibility can be verified at time of your visit to receive the exclusive pricing offered to Med Plan members 3. Med Plan has sent all persons covered in your plan their own membership cards. Each card has its own ID number and must be shown to the provider so that the status of you membership can be verified before services are provided. If the dependent is a minor then it is the responsibility of the minors parent or legal guardian to accompany the minor to all provider visits and services. 4. To locate participating providers in your area, please refer to the Provider Directory provided in your Membership Kit. This directory contains information on all Med Plan contracted providers including pricing for all covered services. Since providers and services are being added monthly, Med Plan has created a website for our members to view all of their membership information which includes updates and new services. To access this information online please call Med Plans Member Service Department and ask for them to you your username and password. For additional provider locations, call the appropriate number on the back of your card or visit: 5. Please remember that Payment for all services must be made directly to the provider at time of service. 6. If you have any questions on how to use your membership, call our Member Services departments at the toll-free number listed on your card for prompt, friendly service. 7. We are located at 7200 NW 7th street Suite 100, Miami FL (305) Our Offices are open Monday through Friday 9:00 a.m. to 5:00 p.m. COMO USAR SU TARJETA DE MIEMBRO Cuando usted visite a un proveedor (Ejemplo: Médico general o Especialista) usted deberá presentar su tarjeta de miembro con una identificación con fotografía (ID) para que su elegibilidad pueda ser verificada en el momento de solicitar sus servicios y pueda beneficiarse de las tarifas preferenciales exclusivas que aplican únicamente a los miembros de MedPlan. Cuando usted visite a proveedor participante usted pagará una tarifa fija preferencial que ha sido establecida para los miembros de MedPlan. Las Tarifas establecidas aparecen en este libro que ha sido incluido dentro del paquete de membrecía que usted recibió. Por favor refiérase a la sección que corresponda dentro de este directorio. Todos los servicios prestados en el consultorio de un médico de atención primaria o especialista usted lo pagará directamente en el momento de recibir los servicios. Solo los médicos y demás proveedores de la red que brindan sus servicios a nuestros miembros, honraran las tasas establecidas. Los proveedores de la red tienen en su poder las mismas tarifas que usted tiene, esto le asegura que lo que usted pagará no puedan ser alterados. MedPlan no le asigna ningún proveedor, usted es libre de elegir dentro del directorio. La información detallada para localizar a un proveedor, dirección, número telefónico, tarifa etc. se encuentra dentro del directorio médico que usted recibió. Usted puede obtener esta información en cualquier momento visitando nuestra página web: Para coordinar su primera cita con un proveedor de la red usted puede elegir cualquiera de las siguientes opciones: a) Llame directamente al proveedor que usted haya elegido. b) Llame a nuestro departamento de atención al cliente al (877) y solicite que se le coordine la cita con el doctor que usted haya elegido. En ese caso tenga a mano el nombre del doctor para que la asistencia sea efectiva y rápida en función de sus necesidades. Nos encontramos en 7200 NW 7th street Suite 100, Miami FL (305) Nuestras oficinas estan abieras de Lunes a Viernes de 9:00 a.m. to 5:00 p.m. 10

11 PRIMARY PHYSICIANS AND SPECIALISTS All services rendered at your primary care physicians office or Specialist will be paid directly to the provider at fix rates that are completely disclosed inside this book. These prices are exclusive to Med Plan members and represent an average savings of 70% percent off the Providers Usual and customary fees. All prices cover service provided at your Physicians office which can include, routine X-rays, EKG s, Ultrasounds and many other services. Services vary from provider to providers depending on equipment each Physician or Specialist practice elects to provide. It s unlimited the access to Primary Care and Specialist Visits. No prior approval is needed. Physician and Specialists address and phone numbers are located inside your Membership kit or on our website www. floridamedplan.com. To schedule an appointment please call the provider you have chosen from the directory. If you need assistance or cannot find a provider near you please call our Customer Service Department for assistance at Only approved and contracted Med Plan Physicians and Specialists will honor the exclusive prices as defined in the Pricing Guide included in your membership kit. Any Diagnostic studies, Laboratory test, Prescription Medication or services ordered by a Med Plan contracted Physician or Specialist must be performed or completed by a Med Plan approved and contracted provider. This will insure that the service and its price are within the scope of the agreements Med Plan has in place with its approved service providers If you need assistance in coordinating these services please feel free to contact our Customer Service Department at Note: If your favorite physician is not already a participating provider, Call our Provider Relation Department to nominate him or her. Have the physicians name, address, and telephone number available when you call. MEDICOS PRIMARIOS Y ESPECIALISTAS Todas las tasas aplican a los servicios prestados en la oficina de los médicos que pueden incluir, rutina de Rayos X, electrocardiogramas, ecografías y muchos otros servicios. Los servicios pueden estar disponibles o no, dependiendo el equipo médico o especialista que usted pueda elegir. Tenga en cuenta que no todos reúnen las mismas condiciones de equipamiento dentro de su consulta médica. Usted cuenta con visitas médicas ilimitadas y además tendrá la libertad de visitar a cualquier médico especialista sin la necesidad de ser referido por su médico primario. Cualquier estudio de Diagnóstico, Examen de Laboratorio, Medicamentos recetados u otro servicio deberá ser indicado por un proveedor que haya sido aprobado o contratado por MedPlan. Esto asegura que el servicio que usted va a recibir y la tasa que va a pagar esta dentro de los acuerdos que MedPlan ha establecido con los proveedores de la red. Si usted necesita ayuda para coordinar estos servicios por favor contacte a nuestro departamento de servicio al cliente (877) Nota: Si su doctor favorito aun no es participante de nuestra red y desea que se integre para que pueda continuar con sus servicios y adaptar nuestras tarifas preferenciales, por favor contacte a nuestro departamento de Relación con Proveedores y ofrezca información precisa del doctor (Nombre, Dirección y Teléfono de su oficina) nosotros nos sentiremos complacidos en contactarlo a mayor brevedad posible y lo invitaremos a que se una a nuestra Red. 11

12 PRIMARY PHYSICIANS / MEDICOS PRIMARIOS Primary Care Physicians / Médicos Primarios Miami - Dade Esperanza A. Nuñez, M.D. (Glez and Gonzalez Medical Center) 1840 W 49th ST Ste # 420 Hialeah, Fl Phone: (305) Esperanza A. Nuñez, M.D. (Glez and Gonzalez Medical Center) 3804 NW 167th Street Opalocka, Fl Phone: (305) John Padron, M.D. (General Practice) (Opa Medical Center) 1865 NE 163th Street North Miami, FL Phone: (305) Armando Segui, M.D. (Ambert Medical Center) Eagle Nest Ln, Suite 100 Miami Lakes, Fl Phone: (305) Humberto Hernandez, M.D West 49th Place, Ste 604 Hialeah, FL Phone: (305) Otneil Hernandez, DNP, ARNP. (Felicidad Medical Center) (Family Medicine) 4410 West. 16th Ave. # 55 Hialeah, Florida Phone (305) Maray Rocher, M.D. (General Practice) 87 E 49 ST Hialeah, FL Phone: (786) Juan C. Romero, M.D. (C&I Medical Center) NW 67th Ave #440 Miami Lakes, Fl Phone: (305) Felix A. Rodriguez, M.D. (American Family Health Center) 2150 W. 68th St, Suite 102 Hialeah, Fl Phone: (305) Gilda de la Calle, M.D West 49th Place Suite 400-B Hialeah, Fl Phone: (305) Lucky Flores, M.D. (Elite Health & Rehabilitation) 6450 West. 21 Ct, Suite 200 Hialeah, Fl Phone: (305) Juan C. Sarol, M.D. (General Practice) 87 E 49 ST Hialeah, FL Phone: (786) Mara De Garcia, M.D. (C&I Medical Center) NW 67th Ave #440 Miami Lakes, Fl Phone: (305) Miguel A. Chamah, M.D West 68th St, Suite 127 Hialeah, FL Phone: (305) Odalys Frontela, M.D. F.A.C.P 801 West 48th St, Suite A Hialeah, FL Phone: (305) Conchita Jackson, M.D. (Vida Health Centers) 881 E 2nd Ave Hialeah, Fl Phone: (305) Viviana Pérez, M.D West. 16 ave Suite 26 Hialeah, Fl Phone: (305)

13 Primary Care Physicians / Médicos Primarios Miami - Dade Miriam Estévez, M.D. 729 E 9 ST Hialeah, FL Phone: (786) Price 1st Visit: $ Price Follow Up: $ Gretell Trullenque, M.D. (Acevedo Medical Group) 2525 NW 54th St. Miami, Fl Phone: (305) Hector Rodriguez, M.D. (Acevedo Medical Group) 2525 NW 54th St. Miami, Fl Phone: (305) Alicia R. Mirabal, M.D. (Clinica Venamer) NW 25th St, Suite 114 Doral, Fl Phone: (305) José Gil, M.D. (Davila Medical Center) 782 NW 42th Ave # 348 Miami, Fl Phone: (305) Amando Viera, M.D. 777 East 25th St. Suite 118 Hialeah, Fl Phone: (305) Mayre Urdaneta, M.D. (General Practice) 8060 NW 155th Street Ste 201 Miami Lakes, Florida Phone: (305) Jorge Martinez, M.D. (St. John Medical Center) 161 NW 29th St Miami, FL Phone: (305) Jose R. Martin, M.D. (Clinica Venamer) NW 25th St. Suite 114 Doral, Fl Phone: (305) Jesús J. Cid, M.D. (Medical Counsulting Center) 759 NW 22 ave Miami, Florida Phone: (305) Edgar N Escobar, M.D. (Florida Care Health Center) NW 87th Court, Suite 141 Hialeah Gardens, Fl Phone: (305) Lucky Flores, M.D. (General Practice) 5881 NW 151 St, Suite 127 Miami Lakes, FL Phone: (305) Juan Delgado, M.D. (Family Medicine) (St. John Medical Center) 161 NW 29th St Miami, FL Phone: (305) Milady Fernandez, M.D. (Clinica Venamer) NW 25th St, Suite 114 Doral, Fl Phone: (305) Jorge L. Santander, M.D. (Holistic Medical Institute) 5040 NW 7th St, Suite 300 Miami, Fl Phone (305) nd Phone: (305) Baudilio Cuzco Prieto, M.D. (Complete Medical Care) 630 NW 33th Ave Miami, Fl Phone: (305) Mario Palomino, M.D. (General Practice) (Private Medical Center) 10 NW 42th Ave, Suite 300 Miami, FL Phone: (305) Valdemir Santos, M.D. (General Practice) (ACN Physician Group) 7490 SW 23 ST #201 Miami, Fl Phone: (786)

14 Primary Care Physicians / Médicos Primarios Miami - Dade Gamaliel Mattos, M.D N.W. 97 ave #101 Doral, Fl Phone: (305) Comfort Adewumi, M.D. (7th Ave. Medical Plaza) NW 7 ave Miami, FL Phone: (305) Fax: (305) Francisco C. Gonzalez, M.D. J.O. Medical Center, Inc. 42 NW 27th Avenue, Suite 303 Miami, FL Phone: (305) Ciro Reyes, M.D N.W. 7th St #207 Miami, Fl Phone: (305) Mauricio Vargas, M.D. (General Practice) (Private Medical Center) 10 NW 42th Avenue, Suite 300 Miami, FL Phone: (305) Julio C. Reyes Gavilan J.O. Medical Center, Inc. 42 NW 27th Avenue, Suite 303 Miami, FL Phone: (305) William Mazzel, M.D. (7th Ave. Medical Plaza) NW 7 ave Miami, FL Phone: (305) Jose Pena, M.D. (General Practice) (Private Medical Center) 10 NW 42th Avenue, Suite 300 Miami, FL Phone: (305) Mario R. Villoch, M.D. (AV Medical Center) 2075 SW 27 ave Suite 101 Miami, Fl Phone: (305) Pedro R. Caro, M.D. (General Practice) Varadero Medical Center 5850 West Flagler ST Miami, Fl Phone: (305) Fax: (305) Julian Guerrero, M.D. (General Practice) 8370 W. Flagler St, Suite 120 Miami, FL Phone: (305) Jose Valiente, M.D. (General Practice) (Flagler Rehabilitation Center Inc.) 4697 W Flagler ST Miami, Fl Phone: (305) Fax: (305) John A. Padron, M.D. (General Practice) 8370 W. Flagler St, Suite 120 Miami, FL Phone: (305) Roberto A. Fernandez, M.D. Latin Foundation for Health 8260 West Flagler St. Suite 2-M Miami, Fl Phone: (305) Fax (305) Jorge L. Santander, M.D. (General Practice) 6621 SW 8 ST Miami, FL Phone: (305) Aurelio A. Ortiz, M.D. (General Practice) 1313 SW 1th Street. Miami, Fl Phone: (305) Hugo Romeu, M.D. (General Practice) (ABC Medical Group) 1393 SW 1th ST Suite 320 Miami, Fl Phone: (305) Gilda de la Calle, M.D. (General Practice) 421 SW 107th Avenue Miami, Fl Phone: (786) Fax: (786)

15 Primary Care Physicians / Médicos Primarios Miami - Dade Oscar Mendez Turino, M.D. Isabel K. Yague, M.D. (General Practice) 1393 SW 1st street # 415 Miami Florida Phone: (786) Abdón S. Borges, M.D. (General Practice) 8300 SW 8th St. Suite 105 Miami, Fl Phone: (305) Fax: (305) Alberto Gonzalez-Gomez, M.D. (General Practice) 7968 SW 8th ST Miami, Fl Phone: (786) Adolfo R. Martínez, M.D SW 8th Street. Miami, Fl Phone: (305) Fax:(305) Josefina Hernández, M.D SW 8th Street. Miami, Fl Phone: (305) Fax:(305) Juan Blemil Fdez. M.D, P.A SW 42th Street Miami, FL Phone: (305) Carlos E. Aguilar, M.D. (Panamerican Sports Medicine Institute of miami) 3850 SW 87 ave Ste 201 Miami, Fl Phone: (305) Julio C. Rosales, M.D. (General medicine) Kendall Medical Plaza SW 40 St # 120 Miami, FL Phone: (305) Fax: Rogelio O. Bardiñas, M.D. 747 Ponce de Leon Blv # 700 Coral Gables, Fl Phone: (305) Hilda M Brito M.D SW 8th Street, Suite 224 Miami, Fl Phone: (305) Rodolfo Vega, M.D. (General Practice) (Vega Medical Center) 3720 SW 107 ave Miami, FL Phone: (305) Francisco Gonzalez, M.D. (Panamerican Sports Medicine Institute of miami) 3850 SW 87 ave Ste 201 Miami, Fl Phone: (305) Florence Faucauld, M.D SW 88th Street, Ste 104 Miami, FL Phone: (305) Ines Rodriguez, ARNP (The Wellnes Clinic Center) SW 136 ST, Suite 15 Miami, FL Phone: (305) Fax: Julio C. Rosales, M.D. (Hammocks Medical Center) SW 72th Street Miami, FL Phone: (305) Antonio Blanco, M.D SW 72th St. Suite 212 Miami, FL Phone: (305) Eduardo Almaguer, M.D. 330 S.W 27th Ave # 404 Miami, Fl Phone: (305) Jorge Santander, M.D S. Dixie Hwy. Naranja, Fl Phone: (305)

16 Primary Care Physicians / Médicos Primarios Miami - Dade Rolando Padro, M.D SW 137th Avenue Miami, FL Phone: (305) Aaron B. Tuckler, M.D S. Dixie Hwy Naranja, Fl Phone: (305) Maria C. Cubillas, M.D. (General Practice) S. Dixie Hwy Homestead, Fl Phone: (305) Maria Delgado, M.D. (General Practice) (Homestead Medical Clinic, M.D) 125 N.E 8th Street Homestead, Fl Phone: (786) WEIGHT LOSS PROGRAM Eduardo Medrano, M.D. (All Family Care Inc.) 38 Northwest 8th Street Homestead, Florida Phone: (305) PROGRAMA DE PERDIDA DE PESO John G. Gutleber, M.D. (General Practice) 139 N.E 15th Street Homestead, Fl Phone: (305) Fax: (305) Ciro Reyes, MD.PA 7200 N.W. 7th St #207 Miami, Fl Phone: (305) Price Follow Up. $30.00 (1st Visit and Follow Up Prices include medicines) (Los precios de la 1ra Visita y las consultas de seguimiento incluyen los medicamentos) Primary Care Physicians / Médicos Primarios Broward Silvia Soto, M.D. (Miramar Medical Center) Miramar Parkway Miramar, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Oli Mendez, M.D. (Miramar Medical Center) Miramar Parkway Miramar, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Elsa Pichardo Matos, M.D. (Sunset Strip Medical Center) 4269 N.W 88 ave Sunrise, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Stacy H. Katz, M.D. (Broward Medical Center of Davie) 255 SE 14 St Suite C-1 Ft. Lauderdale, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Yaneth Trujillo, M.D North Palm Ave. Suite, 102 Pembroke Pines, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ 20.0 Eugene Gregorie, M.D NW 5th Street, Ste 100 Plantation, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Jongairo Catano, M.D W. Menab Rd Suite 112 Tamarac, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Controlled Substance Call for a Schedule Mark Leeds, D.O. PA Hollywood Blvd Hollywood, Fl Phone: (954) Mon-Fri 9am to 5pm Price 1st Visit: $ Price Follow Up: $ Controlled Substance Call for a Schedule 16

17 Primary Care Physicians / Médicos Primarios Daniel Hernández, MD. (Primary Care Physician) 2531 N. Dixie Hwy Lakeworth, Fl Phone: (561) Fax: (561) Price 1st Visit: $ Price Follow Up: $ Gynecology & Obstetrics / Ginecología y Obstetricia Palm Beach Miami - Dade Adrian Marimon, M.D. (Gynecologist / Ginecología)e: (Med Care Medical Center) 7200 N.W 7th Street, Suite 150 Miami, Fl Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Esperanza A. Nuñez M.D. (OB)-(GYN) (Glez. and Glez. Medical Center) 3804 NW 167th Street. Opa-Locka, Fl Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Esperanza A. Nuñez M.D. (OB)-(GYN) 1840 W 49th ST Ste # 420 Hialeah, Fl Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Eduardo Lavado, M.D. (OB-GYN) 4160 W. 16 Avenue, Ste 406 Hialeah, FL Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Tomas Seville, M.D. (OB-GYN). (Holistic Medical Center) 5040 NW 7th street Suite 300 Miami Florida Phone: (305) / Price 1st Visit: $60.00 Price Follow Up. $40.00 Emilio Blanco, M.D. (OB) - (GYN) (Vida Health Centers) 881 East 2nd ave Hialeah FL Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Ramiro Abaunza, M.D. (GYN). (Medical Consulting Center) 3240 NW 7th Street Miami, Florida Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Matias Guerra M.D. (OB-GYN). (ST. John Medical Center) 161 NW 29th Street Miami, FL Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Conchita Jackson, M.D.(GYN)) (Private Medical Center) 10 NW 42 Ave Suite 300 Miami, FL Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Rolando Padro, M.D. (OB) - (GYN) SW 137 Avenue Miami, FL Phone: (305) Price 1st Visit: $60.00 Price Follow Up. $40.00 Gynecology / Ginecología Jongairo Catano, M.D. (Gynecology) 7300 W. Menab Rd Suite 112 Tamarac, Fl Phone: (954) Controlled Substance Call for a Schedule Fernando Lora, M.D. (Gynecologist / Ginecología) (Vital Medical Center) 8300 W Flagler, Suite 175 Miami, FL Phone: (305) Broward 17

18 Pediatrics / Pediatría Miriam Estévez, M.D. (Pediatrician / Pediatra) 729 E 9 ST Hialeah, FL Phone: (786) Price 1st Visit: $ Price Follow Up: $ Armando Acevedo, M.D. (Pediatrician / Pediatra) (Acevedo Medical Group) 2525 NW 54th Street. Miami, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Eduardo Díaz, M.D. (Pediatrician / Pediatra) 5703 NW 7 ST Miami, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Otneil Hernandez, DNP, ARNP. (Pediatrician/Pediatra) 4410 West. 16th Ave. # 55 Hialeah, Florida Phone (305) Price Follow Up. $30.00 Maria I. Delgado, M.D. (Pediatrician / Pediatra) 7815 SW 24th street, Suite 106 Miami, Fl Phone: (305) Price Follow Up. $30.00 Armando Segui, M.D. (Pediatrician / Pediatra) (Ambert Medical Center) Eagle Nest Ln, Suite 100 Miami Lakes, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Juan Del Sol, M.D. (Pediatrician / Pediatra) (ST. John Medical Center) 161 NW 29th Street Miami, FL Phone: (305) Price 1st Visit: $ Price Follow Up: $ Hilda M. Brito, M.D. (Pediatrician / Pediatra) SW 8th Street, Suite 224 Miami, Fl Phone: (305) Price Follow Up. $30.00 Rodolfo Sidron, M.D. (Pediatrician / Pediatra) 7285 W Flagler St Miami, Fl Phone: (786) Price 1st Visit: $ Price Follow Up: $ Rodolfo B. Ferretti M.D. (Pediatrician / Pediatra) 7765 SW 87 Avenue Suite 209 Miami, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Miami - Dade Jorge L. Alsina, M.D. (Pediatrician / Pediatra) 4980 W. 10 Ave. Suite, 204 Hialeah, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Ivette Valle, M.D. (Pediatrician / Pediatra) (ST. John Medical Center) 161 NW 29th Street Miami, FL Phone: (305) Price 1st Visit: $ Price Follow Up: $ Gloria López, M.D. (Pediatrician / Pediatra) 747 Ponce de Leon Blv, Ste 607 Coral Gables, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Pedro C. Reimon, M.D. (Child Obesity Specialist) SW 42nd Street Ste 106 Miami Florida Phone: (305) Price 1st Visit: $ Price Follow Up: $ Francisco Martinez, M.D. (Pediatrician / Pediatra) SW 72th ST Miami, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Juan Ruiz, M.D. (Pediatrician / Pediatría) 8900 SW 24 ST #204 Miami, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Dorses Goosby, M.D. (Pediatrician / Pediatría) (Pediatric Ass. of Florida) 151 N.W 11th St. Ste E-202 Homestead, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $ Alfredo Machado, M.D. (Pediatrician / Pediatría) (Pediatric Ass. of Florida) 151 N.W 11th St. Ste E-202 Homestead, Fl Phone: (305) Price 1st Visit: $ Price Follow Up: $

19 Pediatrics / Pediatría Miami - Dade Milady Fernandez, M.D. (All Family Care Inc.) 38 Northwest 8 Street Homestead, Florida Phone: (305) Price 1st Visit: $ Price Follow Up: $ Marta Delgado, M.D. (Pediatrician / Pediatría) (Homestead Medical Clinic PA) 125 NE 8th St # 6 Homestead, Fl Phone: (786) Price 1st Visit: $ Price Follow Up: $ Pediatrics / Pediatría Broward Antonio Wong, MD (7 years and up) (Doctors Plus Medical Center) 501 NW 179 Avenue Pembroke Pines, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Yuelice Villamar, M.D. (Sacred Hearth Medical) (Pediatric) N.W. 5 St. # 205 Pembroke Pines, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ 30.0 Pediatrics / Pediatría Juan F. Arteaga, MD (7 years and up) (Doctors Plus Medical Center) 501 NW 179 Avenue Pembroke Pines, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Meeta Govindarajan, MD (7 years and up) (Doctors Plus Medical Center) 501 NW 179 Avenue Pembroke Pines, Fl Phone: (954) Price 1st Visit: $ Price Follow Up: $ Collier Héctor Cordero, M.D. (Pediatrician / Pediatra) th Ave N Naples, Fl Phone: (239) Pediatrics / Pediatría Palm Beach Bradley J. Bradford, M.D. (Pediatrician / Pediatra) (Pediatrics by the Sea) 285 SE 5th Ave Delray Beach, FL 3483 Phone: (561) Fax: (561)

20 20

305-262-1610 305-262-1610 PREMIER PLAN PREMIERE PLAN. Provider Directory. Provider Directory MED PLAN MED PLAN

305-262-1610 305-262-1610 PREMIER PLAN PREMIERE PLAN. Provider Directory. Provider Directory MED PLAN MED PLAN 2015 MED PLAN Affordable Health Solutions PREMIER PLAN Provider Directory Florida Office of Insurance Regulation: Med Plan, LLC Date of Insurance: July 27, 2010 N 10-800522755 MEMCOM-MEMHND-001 V07/14/2015

Más detalles

Guide to Health Insurance Part II: How to access your benefits and services.

Guide to Health Insurance Part II: How to access your benefits and services. Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find

Más detalles

4950 SW 8 Street Coral Gables, FL 33134 (305) 447-8373

4950 SW 8 Street Coral Gables, FL 33134 (305) 447-8373 Urgent Care Facilities Commercial Broward and Miami-Dade County 4950 SW 8 Street Coral Gables, FL 33134 (305) 447-8373 Table of Content Broward County Ancillary Services Urgent Care 1 Miami-Dade County

Más detalles

TABLA DE CONTENIDOS. Primary and Specialist Providers Fees / Precios de los servicios medicos primarios y especialistas...20

TABLA DE CONTENIDOS. Primary and Specialist Providers Fees / Precios de los servicios medicos primarios y especialistas...20 305-262-1610 TABLA DE CONTENIDOS Membership Agreement / Acuerdo de Membrecia...7 Welcome Letter / Carta de Bienvenida...8 Terms and Conditions / Términos y Condiciones...9 How to Use Your Card? / Cómo

Más detalles

TABLE OF CONTENTS / TABLA DE CONTENIDO

TABLE OF CONTENTS / TABLA DE CONTENIDO 305-262-1610 TABLE OF CONTENTS / TABLA DE CONTENIDO Membership Agreement / Acuerdo de Membrecia...7 Welcome Letter / Carta de Bienvenida...8 Terms and Conditions / Términos y Condiciones...9 How to Use

Más detalles

TABLE OF CONTENTS / TABLA DE CONTENIDO

TABLE OF CONTENTS / TABLA DE CONTENIDO 305-262-1610 TABLE OF CONTENTS / TABLA DE CONTENIDO Membership Agreement / Acuerdo de Membrecia...7 Welcome Letter / Carta de Bienvenida...8 Terms and Conditions / Términos y Condiciones...9 How to Use

Más detalles

PREMIER PLAN 305-262-1610. Provider Directory. w w w. f l o r i d a m e d p l a n. c o m

PREMIER PLAN 305-262-1610. Provider Directory. w w w. f l o r i d a m e d p l a n. c o m 2014 PREMIER PLAN Provider Directory 305-262-1610 Florida Office of Insurance Regulation: Med Plan, LLC Date of Insurance: July 27, 2010 N 10-800522755 MEMCOM-MEMHND-001 V08/19/2014 w w w. f l o r i d

Más detalles

SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions

SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions The Family Health Center (FHC) Healthy Children Vaccination Program at SF General Hospital (SFGH) provides immunization services

Más detalles

Janssen Prescription Assistance. www.janssenprescriptionassistance.com

Janssen Prescription Assistance. www.janssenprescriptionassistance.com Janssen Prescription Assistance www.janssenprescriptionassistance.com Janssen Prescription Assistance What is Prescription Assistance? Prescription assistance programs provide financial help to people

Más detalles

Welcome to the CU at School Savings Program!

Welcome to the CU at School Savings Program! Welcome to the CU at School Savings Program! Thank you for your interest in Yolo Federal Credit Union s CU at School savings program. This packet of information has everything you need to sign your child

Más detalles

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms I M P O R T A N T News Flash! A FAX Publication for Providers of Sharp Health Plan To: From: Primary & Specialty Care Providers Sharp Health Plan Date: February 17, 2012 Subject: Member Grievance Forms

Más detalles

Purpose of Sliding Scale Policy and Procedure Disclaimer Policy

Purpose of Sliding Scale Policy and Procedure Disclaimer Policy San Luis Valley Health s Behavioral Health department offers a sliding fee discount program to eligible patients. If you would like more information, please call 589-8008, or ask one of our Admitting Clerks

Más detalles

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner

Más detalles

Important News About Your Health Plan

<P.O. Box 3418> <Scranton, PA 18505> Important News About Your Health Plan December 1, 2015 Dear UI Health Plus Member, Important News About Your Health Plan Your health plan, UI Health Plus, has joined Blue Cross Community Family Health Plan.

Más detalles

Health Plan of Nevada, Inc.

Health Plan of Nevada, Inc. HMO Option 1 Lifetime Maximum Benefit $1,000,000 Annual Copayment Maximum $2,000 per Member / $4,000 per Family Covered Services Physician Services - Office Visit/Consultation Hospital Services - Elective

Más detalles

PORQUE SE TRATA DE IT S ALL ABOUT USTED! YOU!

PORQUE SE TRATA DE IT S ALL ABOUT USTED! YOU! YOU! PORQUE SE TRATA DE USTED! THE SERVICE EL SERVICIO ES LO MÁS IMPORTANTE WHEN IT COMES TO OBTAINING QUALITY HEALTHCARE, NOTHING IS MORE IMPORTANT THAN THE QUALITY OF CARE AND THE SERVICE YOU RECEIVE.

Más detalles

Affordable Care Act Informative Sessions and Open Enrollment Event

Affordable Care Act Informative Sessions and Open Enrollment Event 2600 Cedar Ave., P.O. Box 2337, Laredo, TX 78044 Hector F. Gonzalez, M.D., M.P.H Tel. (956) 795-4901 Fax. (956) 726-2632 Director of Health News Release. Date: February 9, 2015 FOR IMMEDIATE RELEASE To:

Más detalles

Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP

Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP Sistema de registro y pago Este sistema está dividido en dos etapas diferentes*. Por favor, haga clic en la liga de la etapa

Más detalles

MajestaCare Healthy Baby Program

MajestaCare Healthy Baby Program MajestaCare Healthy Baby Program Helping you have a healthy baby Para que tenga un bebé saludable Your baby s provider After your baby becomes a member of MajestaCare health plan, you will get a letter

Más detalles

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid

Más detalles

School Preference through the Infinite Campus Parent Portal

School Preference through the Infinite Campus Parent Portal School Preference through the Infinite Campus Parent Portal Welcome New and Returning Families! Enrollment for new families or families returning to RUSD after being gone longer than one year is easy.

Más detalles

Limited TWO-YEAR Warranty SENSIO Inc. hereby warrants that for a period of TWO YEARS from the date of purchase, this product will be free from mechanical defects in material and workmanship, and for 90

Más detalles

2015 DENTAL DIRECTORY

2015 DENTAL DIRECTORY 2015 DENTAL DIRECTORY DIRECTORIO DENTAL 2015 County / Condado: EL PASO H5928_15_003_PNO_DENTAL_EP Accepted H5928_15_003_PNO_DENTAL_EP_SPA Accepted Care1st Health Plan HMO Plan Provider Directory This directory

Más detalles

How to navigate your PlanBien SM health care coverage plan

How to navigate your PlanBien SM health care coverage plan Learn how to navigate your health care coverage plan through this easy-to-understand brochure. How to navigate your PlanBien SM health care coverage plan Selecting a health care coverage plan requires

Más detalles

Creating your Single Sign-On Account for the PowerSchool Parent Portal

Creating your Single Sign-On Account for the PowerSchool Parent Portal Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to

Más detalles

www.deltadentalins.com/language_survey.html

www.deltadentalins.com/language_survey.html Survey Code: Survey 1 February 6, 2008 Dear Delta Dental Enrollee: Recent changes in California law will require that all health care plans provide language assistance to their plan enrollees beginning

Más detalles

DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS

DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DAVID L. LAKEY, M.D. DIRECTOR P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY (teletipo): 1-800-735-2989 www.dshs.state.tx.us 1 de marzo,

Más detalles

Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP

Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? Columbia Presbyterian Center NewYork-Presbyterian Hospital

Más detalles

TITLE VI COMPLAINT FORM

TITLE VI COMPLAINT FORM [CITY SEAL/EMBLEM] The Capital City of the Palm Beaches TITLE VI COMPLAINT FORM Title VI of the 1964 Civil Rights Act requires that "No person in the United States shall, on the ground of race, color or

Más detalles

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Headaches, Working with your Doctor to Avoid the Emergency Room Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Conozca a su equipo de cuidados para los dolores

Más detalles

ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights

ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights ODJFS Bureau of Civil Rights I NEED AN INTERPRETER, PLEASE. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin. If you do not speak English well, social services,

Más detalles

HEAD START MEDICATION ADMINISTRATION

HEAD START MEDICATION ADMINISTRATION HEAD START MEDICATION ADMINISTRATION Dear Parents/Guardians: It is the policy of Head Start to cooperate with each Head Start child's parent/guardian and his/her physician by administering and providing

Más detalles

Tarjetas de crédito Visa y Mastercard a través de la pagina de inscripción al curso. (En Argentina no se acepta Amex)

Tarjetas de crédito Visa y Mastercard a través de la pagina de inscripción al curso. (En Argentina no se acepta Amex) Terminos y Condiciones PAGOS El pago del curso deberá en todos los casos efectivizado como mínimo - 72 horas antes del comienzo del mismo. La vacante será confirmada contra el pago del curso, hasta ese

Más detalles

AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES

AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES SCOPE OF POLICY This policy applies to all agency staff members. Agency staff members include all employees, trainees, volunteers, consultants, students,

Más detalles

Cover Florida Plan I Understanding Your Share

Cover Florida Plan I Understanding Your Share Cover Florida Plan I Understanding Your Share for Covered Services Our limited health benefit plan under Cover Florida offers a new solution to Floridians looking for affordable health coverage. We make

Más detalles

Northwestern University, Feinberg School of Medicine

Northwestern University, Feinberg School of Medicine Improving Rates of Repeat Colorectal Cancer Screening Appendix Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone Call... 4 Automated

Más detalles

POLICA FINANCERIA Y CONSENTIMENTO PARA TRATAMENTO

POLICA FINANCERIA Y CONSENTIMENTO PARA TRATAMENTO POLICA FINANCERIA Y CONSENTIMENTO PARA TRATAMENTO Nuestra Póliza Financiera: Nuestros doctores y personal están muy preocupados de los costos de su tratamiento medico y queremos discutiré algunos temas

Más detalles

Employee Medical Plan Premium Rates

Employee Medical Plan Premium Rates Employee Medical Plan Premium Rates Coverage Monthly/Salary 130 Hours 140 Hours 150 Hours Each employer may choose to cover all of its Employees Field Employees Field Employees Field Employees employees

Más detalles

Salud Plan Highlights

Salud Plan Highlights Salud con Health Net Groups Salud Plan Highlights HMO, PPO and EPO Health care coverage for your diverse workforce Herminia Escobedo, Health Net We get members what they need. Salud con Health Net Latino

Más detalles

We look forward to hearing from you soon!

We look forward to hearing from you soon! Larry Meredith, Ph.D., Director DIVISION OF SOCIAL SERVICES Public Assistance Branch CHILDRENS HEALTH INITIATIVE is LOW-COST HEALTH INSURANCE FOR KIDS IN MARIN under 19 years of age! The goal of the Children

Más detalles

FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT. Procedures for Filing Your Claim

FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT. Procedures for Filing Your Claim FINANCIAL MANAGEMENT SERVICES RISK MANAGEMENT Procedures for Filing Your Claim Notice: Prerequisite to Lawsuit for Damages Charter XXVII, Section 25, Charter of the City of Fort Worth States in part,.

Más detalles

Daly Elementary. Family Back to School Questionnaire

Daly Elementary. Family Back to School Questionnaire Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire

Más detalles

Welcome to your NURSE ADVICE LINE 1-800-562-4620. Adentro encontrará la versión en Español

Welcome to your NURSE ADVICE LINE 1-800-562-4620. Adentro encontrará la versión en Español Welcome to your NURSE ADVICE LINE Adentro encontrará la versión en Español Welcome to your NURSE ADVICE LINE What should I do? Emergency Room? Urgent Care Center? You re not alone! A few minutes is all

Más detalles

EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS

EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS For employers who set up and maintain retirement plans, the setup costs, annual administrative costs, and retirement-related employee education costs are

Más detalles

Puede pagar facturas y gastos periódicos como el alquiler, el gas, la electricidad, el agua y el teléfono y también otros gastos del hogar.

Puede pagar facturas y gastos periódicos como el alquiler, el gas, la electricidad, el agua y el teléfono y también otros gastos del hogar. SPANISH Centrepay Qué es Centrepay? Centrepay es la manera sencilla de pagar sus facturas y gastos. Centrepay es un servicio de pago de facturas voluntario y gratuito para clientes de Centrelink. Utilice

Más detalles

CO148SPA.1206 PAGE 1 OF 3

CO148SPA.1206 PAGE 1 OF 3 Assurance of Support Algunos inmigrantes necesitan obtener una Assurance of Support (AoS) (Garantía de mantenimiento) antes de que se les pueda conceder su visado para vivir en Australia. El Department

Más detalles

CNS Paragraph Form Date: 09.02.11

CNS Paragraph Form Date: 09.02.11 CNS Paragraph Form Date: 09.02.11 Program Area 03 (01=PA, 02=FS, 03=MA, 04=HP) Paragraph Number U0223 Version Number 00001 Effective Date 2011 Title Administrative Renewal for Aged, Blind and Disabled,

Más detalles

Welcome Savers! 1. Fill out application form if you re not already a Yolo FCU member.

Welcome Savers! 1. Fill out application form if you re not already a Yolo FCU member. Welcome Savers! Yolo Federal Credit Union and Montgomery Elementary School have teamed up again this year to bring you our school saving program! It s easy to participate... 1. Fill out application form

Más detalles

Southern California Lumber Industry Retirement Fund

Southern California Lumber Industry Retirement Fund Southern California Lumber Industry Retirement Fund Established Jointly by Employers and Local Unions Telephone (562) 463-5080 (800) 824-4427 Facsimile (562) 463-5894 www.lumberfund.org January 9, 2015

Más detalles

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone

Más detalles

New Health Insurance Marketplace Coverage Options and Your Health Coverage

New Health Insurance Marketplace Coverage Options and Your Health Coverage New Health Insurance Marketplace Coverage Options and Your Health Coverage Form Approved OMB No. 1210-0149 (expires 11-30-2013) PART A: General Information When key parts of the health care law take effect

Más detalles

PREMIUM BOOKLET B U PA GROUP

PREMIUM BOOKLET B U PA GROUP PREMIUM BOOKLET B U PA GROUP EFFECTIVE JANUARY 1, 2015 ADMINISTRATIVE NOTES Rates are in U.S. dollars and don t include taxes. Rates do not apply to Puerto Rico, the U.S. Virgin Islands, or Brazil. An

Más detalles

Beneficios destacados

Beneficios destacados Condado de San Diego 2016 Beneficios destacados Classic Plan (HMO) Signature Plan (HMO) Heart First Plan (HMO SNP) Condado de San Diego Detalles del plan CLASSIC HEART FIRST Prima mensual del plan $0 $69

Más detalles

Welcome to the Leaders Only Invitation!

Welcome to the Leaders Only Invitation! Welcome to the Leaders Only Invitation! Q & A A. Ultimate Cycler is here to stay! UC remains completely intact and is complementary to FreeToolBox. As a matter of fact, Ultimate Cycler is getting a facelift!

Más detalles

Administración de ingresos. Voluntaria

Administración de ingresos. Voluntaria Administración de ingresos Voluntaria Qué es Administración de ingresos (Income Management)? La Administración de ingresos (Income Management) es una manera de ayudarle a administrar su dinero a fin de

Más detalles

A los niños que tienen Medicaid (Asistencia Médica) Jamás debe. cobrárseles unacantidad por las recetas médicas aún cuando tengan

A los niños que tienen Medicaid (Asistencia Médica) Jamás debe. cobrárseles unacantidad por las recetas médicas aún cuando tengan Disability Rights Network of Pennsylvania 1414 N. Cameron Street Second Floor Harrisburg, PA 17103-1049 (800) 692-7443 (Voice) (877) 375-7139 (TDD) www.drnpa.org A los niños que tienen Medicaid (Asistencia

Más detalles

Asistencia para cuidado infantil

Asistencia para cuidado infantil SPANISH Asistencia para cuidado infantil El Gobierno Australiano ofrece una gama de pagos y servicios para ayudar a las familias con los costes de cuidado infantil incluyendo: Child Care Benefit para cuidado

Más detalles

Chattanooga Motors - Solicitud de Credito

Chattanooga Motors - Solicitud de Credito Chattanooga Motors - Solicitud de Credito Completa o llena la solicitud y regresala en persona o por fax. sotros mantenemos tus datos en confidencialidad. Completar una aplicacion para el comprador y otra

Más detalles

Lump Sum Final Check Contribution to Deferred Compensation

Lump Sum Final Check Contribution to Deferred Compensation Memo To: ERF Members The Employees Retirement Fund has been asked by Deferred Compensation to provide everyone that has signed up to retire with the attached information. Please read the information from

Más detalles

ALERT. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and:

ALERT. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and: ALERT Customers who received a premium tax credit in 2014 and are preparing to renew his/her health coverage for 2016 are required to have filed his/her 2014 taxes in order to continue receiving his/her

Más detalles

CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES

CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES CHILD SUPPORT WORKSHEET HELPLINE INFORMATIONAL LETTER TO LITIGANT Estimado Pro Se Litigante, Dear Pro Se Litigant,

Más detalles

Benefits at a Glance. Greater New York Regional Hotel Plan 105 IMPORTANT PHONE NUMBERS

Benefits at a Glance. Greater New York Regional Hotel Plan 105 IMPORTANT PHONE NUMBERS Greater New York Regional Hotel Plan 105 Benefits at a Glance The Plan provides two levels of benefits Class I and Class II each determined by the number of days of work you are credited with during a

Más detalles

RENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92

RENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92 FELIX E. ROQUE, MD MAYOR DEPT. OF PUBLIC AFFAIRS RENT CONTROL BOARD RENTAL AGREEMENT APPLICATION NAME OF ADDRESS OF LANDLORD: PROPERTY ADDRESS: APARTMENT #: 3 COPIES (1) Original rental agreement signed

Más detalles

Long Beach/Orange County Plan

Long Beach/Orange County Plan Plan 278 Kaiser HMO Long Beach/Orange County Plan Benefit Summary Medical and Dental SUMMARY OF BENEFITS MEDICAL HMO The following is a summary of the benefits payable under the Kaiser Permanente HMO.

Más detalles

P.O. BOX en Miami + Correspondencia Local

P.O. BOX en Miami + Correspondencia Local Gracias por permitirnos presentarles nuestras tarifas y beneficios. P.O. BOX en Miami + Correspondencia Local TIPO DE SERVICIO PLANES PRECIO MENSUAL EXCEDENTES POR GRAMO Plan Silver 2 Kilos / Mes $30 $0.011

Más detalles

Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts?

Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts? Albany Housing Authority RESIDENT COMMISSIONER ELECTION Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts? RUN FOR RESIDENT COMMISSIONER

Más detalles

TITLE VI COMPLAINT FORM

TITLE VI COMPLAINT FORM TITLE VI COMPLAINT FORM Before filling out this form, please read the Arcata and Mad River Transit System Title VI Complaint Procedures located on our website or by visiting our office. The following information

Más detalles

2014 Dental DIReCtORY

2014 Dental DIReCtORY 2014 Dental DIReCtORY DIReCtORIO Dental 2014 Care1st HealtH Plan Kern ChoiCe plan (hmo) Dental health services H5928_14_274_PNO_DENTAL2_REV Accepted H5928_14_274_PNO_DENTAL2_REV_SPA Accepted Care1st Health

Más detalles

AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION

AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION FORM 16-1 AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION Completion of this document authorizes the disclosure and use of health information about you. Failure to provide all information requested

Más detalles

ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL

ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL Nebraska State Court Form REQUIRED Formulario del Tribunal del Estado de Nebraska REQUERIDO ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN

Más detalles

Required Documentation for Charity Care

Required Documentation for Charity Care Patchogue, New York 11772 Required Documentation for Charity Care The completed signed application listing all family members, must be filled out and returned to the Patient Financial Services Department

Más detalles

Guide to Health Insurance Part I: What you need to know before you apply.

Guide to Health Insurance Part I: What you need to know before you apply. Guide to Health Insurance Part I: What you need to know before you apply. 1. What is health insurance and how does it help? Having health insurance protects you in the case of an emergency or sudden illness

Más detalles

Los Angeles Urgent Care Locations. Benefits of an Urgent Care Clinic: 866.293.0134 CALL OUR 24-HOUR NURSE HELP LINE:

Los Angeles Urgent Care Locations. Benefits of an Urgent Care Clinic: 866.293.0134 CALL OUR 24-HOUR NURSE HELP LINE: Los Angeles Urgent Care Locations EHS Urgent Care Facility Locations & Hours Near You Benefits of an Urgent Care Clinic: Costs less than visits See a doctor in 30 min. or less No appointment required Open

Más detalles

For more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer.

For more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer. CAPROCK Claims Management, LLC ROCK SOLID PERFORMANCE AND RESULTS PO Box 743427 Dallas, TX 75374 (888) 812-3577 Fax (972) 934-3091 IMPORTANT NOTICE FOR REQUIRED FILING FORMS DWC FORM-5 & DWC FORM-7 Caprock

Más detalles

BIENVENIDOS A LA OFICINA DEL DR. VICTOR LOOS. Por favor revise y llene las siguientes formas:

BIENVENIDOS A LA OFICINA DEL DR. VICTOR LOOS. Por favor revise y llene las siguientes formas: BIENVENIDOS A LA OFICINA DEL DR. VICTOR LOOS Por favor revise y llene las siguientes formas: Notice of Privacy of Policy (Aviso de privacidad al paciente) Leer y puede quedarse con él Informacion del Cliente

Más detalles

INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN

INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN Informacion importante de saber: Una guarderia de niños para familias consite de un niño hasta 6 niños. Una

Más detalles

MISSISSIPPI EMPLOYEES

MISSISSIPPI EMPLOYEES 1961 Diamond Springs Road Virginia Beach, VA 23455 Phone (757) 460-6308 Fax (757) 457-9345 MISSISSIPPI EMPLOYEES MANCON Employees, Included in this packet is the following information: 1. Job Insurance

Más detalles

Summer Reading Program. June 1st - August 10th, 2015

Summer Reading Program. June 1st - August 10th, 2015 June 1st - August 10th, 2015 Dear Educator, Attached you will find three flyer templates. You can use any of these templates to share your Group Number (GN) with your group participants. 1. 2. 3. The first

Más detalles

Nehemías Toro Insurance Agent. Presenta/Presents: First Medical Health Plan Inc.

Nehemías Toro Insurance Agent. Presenta/Presents: First Medical Health Plan Inc. Nehemías Toro Insurance Agent Presenta/Presents: First Medical Health Plan Inc. PO Box 182 Mayagüez, PR 00681-0182 Tel. (787) 832-0555 Fax: (787) 832-0545 E-mail: nti@nehemiastoro.com Web Site: www.nehemiastoro.com

Más detalles

Servicio de Reclamos Amadeus Guía Rápida

Servicio de Reclamos Amadeus Guía Rápida Servicio de Reclamos Amadeus Guía Rápida 2013 Amadeus North America, Inc. All rights reserved. Trademarks of Amadeus North America, Inc. and/or affiliates. Amadeus is a registered trademark of Amadeus

Más detalles

I am the parent or legal guardian of.

I am the parent or legal guardian of. EXHIBIT Descriptive Code: IFCB-R/E (2) FIELD TRIPS AND EXCURSIONS Date: March 9, 2006 Clarke County School District Student Travel Authorization and Teacher ation Form To SCHOOL: I am the parent or legal

Más detalles

Canutillo Middle School 7311 Bosque, P.O. Box 100 Canutillo, Texas 79835 (915) 877-7900 Fax (915) 877-7919

Canutillo Middle School 7311 Bosque, P.O. Box 100 Canutillo, Texas 79835 (915) 877-7900 Fax (915) 877-7919 Mark Paz August 24, 2015 Dear Parents/Legal Guardian, I would like to start by thanking each and every single one of you for the tremendous help and support we have been receiving. Thank You! Next school

Más detalles

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK 2012 Start Smart for Your Baby. All rights reserved. TM 2012 Start Smart for Your Baby. All rights reserved. TM DIARIO DEL EMBARAZO www.startsmartforyourbaby.com

Más detalles

GUIDE FOR PARENT TEACHER CONFERENCES

GUIDE FOR PARENT TEACHER CONFERENCES GUIDE FOR PARENT TEACHER CONFERENCES A parent-teacher conference is a chance for you and your child s teacher to talk. You can talk about how your child is learning at home and at school. This list will

Más detalles

Servicio de Reclamos Amadeus Guía Rápida

Servicio de Reclamos Amadeus Guía Rápida Servicio de Reclamos Amadeus Guía Rápida 2013 Amadeus North America, Inc. All rights reserved. Trademarks of Amadeus North America, Inc. and/or affiliates. Amadeus is a registered trademark of Amadeus

Más detalles

Starting October 1, 2013, you will have a new provider network.

Starting October 1, 2013, you will have a new provider network. #### STATE OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF HEALTH CARE FINANCE AND ADMINISTRATION COVER TENNESSEE PROGRAMS 310 GREAT CIRCLE ROAD, 2 WEST NASHVILLE, TENNESSEE 37243 DATE

Más detalles

GUIDE FOR DURABLE MEDICAL EQUIPMENT USED IN THE HOME GUÍA DE EQUIPO MÉDICO DURADERO USADO EN LA CASA

GUIDE FOR DURABLE MEDICAL EQUIPMENT USED IN THE HOME GUÍA DE EQUIPO MÉDICO DURADERO USADO EN LA CASA 2014 GUIDE FOR DURABLE MEDICAL EQUIPMENT USED IN THE HOME GUÍA DE EQUIPO MÉDICO DURADERO USADO EN LA CASA H5928_14_362_DME Accepted H5928_14_362_DME_SPA Accepted DURABLE MEDICAL EQUIPMENT AND RELATED SUPPLIES

Más detalles

Estimado Empresario. Logística de Transporte y hoteles /Logistics. Patricia Alvarez M. 2597980 ext 314 +593 981198778 palvarezm@proecuador.gob.

Estimado Empresario. Logística de Transporte y hoteles /Logistics. Patricia Alvarez M. 2597980 ext 314 +593 981198778 palvarezm@proecuador.gob. Estimado Empresario Es un gusto poder contar con su participación en la V rueda de Negocios Aromas del Ecuador 2015. Adjunto encontrará el instructivo de participantes, detalle de transportes y el horario

Más detalles

\RESOURCE\ELECTION.S\PROXY.CSP

\RESOURCE\ELECTION.S\PROXY.CSP The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about

Más detalles

PB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11)

PB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11) FAMILY INDEPENDENCE ADMINISTRATION Matthew Brune, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Stephen Fisher, Assistant Deputy Commissioner Office

Más detalles

NOTICE OF FORM CHANGE NO. 06-028

NOTICE OF FORM CHANGE NO. 06-028 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE OF FORM CHANGE NO. 06-028 DATE 02/23/2006 TO: County Welfare Director Supply Clerk / Forms Coordinator

Más detalles

CONSENT FOR HIV BLOOD TEST

CONSENT FOR HIV BLOOD TEST i have been informed that a sample of my blood will be obtained and tested to determine the presence of antibodies to human immunodeficiency Virus (hiv), the virus that causes Acquired immune Deficiency

Más detalles

2014 Dental DIReCtORY

2014 Dental DIReCtORY 2014 Dental DIReCtORY DIReCtORIO Dental 2014 Care1st HealtH Plan Kern ChoiCe plan (hmo) Dental health services. H5928_14_274_PNO_DENTAL2 Accepted H5928_14_274_PNO_DENTAL2_SPA Accepted Care1st Health Plan

Más detalles

Formulario Breve de Solicitud de Inscripción en Medicare Advantage 2015

Formulario Breve de Solicitud de Inscripción en Medicare Advantage 2015 Planes Health Net Medicare Advantage Formulario Breve de Solicitud de Inscripción en Medicare Advantage 2015 Nombre del Plan En el que se Inscribirá: Health Net Healthy Heart (HMO) (incluye cobertura de

Más detalles

Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años

Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años FREE GRATIS Beacon Programs Adult Enrollment Form Beacon PROGRAMS Participant Information

Más detalles

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS PRINTING INSTRUCTIONS 1. Print the Petition form on 8½ X 11inch paper. 2. The second page (instructions for circulator) must be copied on the reverse side of the petition Instructions to print the PDF

Más detalles

Revised Errata Sheet to the Mercy Maricopa Advantage 2015 Evidence of Coverage

Revised Errata Sheet to the Mercy Maricopa Advantage 2015 Evidence of Coverage Revised Errata Sheet to the Mercy Maricopa Advantage 2015 Evidence of Coverage April 22, 2015 This is important information on changes in your Mercy Maricopa Advantage coverage. We previously sent you

Más detalles

Salud HMO y Más Plans

Salud HMO y Más Plans Salud con Salud HMO y Más Plans Latino focused. Community centered. Budget friendly. Mark Rivera, We help members build healthy habits. Salud HMO y Más A Different Kind of Health Plan You deserve the most

Más detalles

NOTICE REQUIRED BY DELAWARE LAW: TAKE ACTION TO SAVE YOUR HOME FROM FORECLOSURE

NOTICE REQUIRED BY DELAWARE LAW: TAKE ACTION TO SAVE YOUR HOME FROM FORECLOSURE DTA.ID00090 DTA.ID00091 DTA.ID00092 DTA.ID00093, DTA.ID00094 DTA.ID00095 DTA.ID00096 DTA.ID00097 DTA.ID00098 DTA.ID00099 DTA.ID00100, DTA.ID00101 DTA.ID00102 DTA.ID00103 Notice of Intent to Foreclose (Delaware)

Más detalles

Pistas Separadas TÉRMINOS Y CONDICIONES

Pistas Separadas TÉRMINOS Y CONDICIONES Pistas Separadas POETA MUSIC PRODUCTIONS le da un control total sobre lo que se hace con la grabación original. Ahora, usted puede agregar diferentes sonidos voses teclados derivados como desee ( añada

Más detalles