Online resources and how to contact us ; Prior authorization and notification requirements, Empire Plan supplement - 2022 UnitedHealthcare Administrative Guide . All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan's unique terms. Please call 1-888-830-4300 to reach one of our care managers. New York State Health Insurance Program - Empire Plan Health (1 days ago) WebNYSHIP covers over 1.2 million active and retired State and participating organizations' employees and their dependents (collectively referred to as members). The site will remember your group for future visits. Can I get a paper copy of the Summary of Benefits and Coverage if I need one? Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. File your paperwork promptly and within the time limit. TTY: 711 If your state isn't listed, check out bcbs.com to find coverage in your area. Empire Plan Toll free. Main Campus Office: S-5415 Melville Library. Starting Jan. 1, 2021, members of The Empire Plan will have in-network access to the UnitedHealthcare Options preferred provider organization (PPO) network for all states and U.S. territories outside of New York. Your HBA, usually located in your agency's personnel office, can also print you . call the Empire Plan at 1-877-7-NYSHIP (1-877-769-7447), select option 4. April 20, 2022 by tamble. administered by Davis Vision. Cancer Resource Services . Keep a receipt when you pay your bill. Log in to your member account to view your claims and EOBs. treatment before your NYSHIP card arrives, your provider can confirm your enrollment Need access to the UnitedHealthcare Provider Portal? What is NYSHIP? If you need a paper copy of the Summary of Benefits and Coverage or the Uniform Glossary for a NYSHIP HMO, please contact the HMO. About Us \. It has important information and phone numbers. The Empire Plan Supplement will be included with the 2021 UnitedHealthcare Care Provider Administrative Guide. The Empire Plan, New York State Health Insurance Program, https://nyrmo.optummessenger.com/public/opensubmit. The first set reflects 2023 biweekly rates for CSEA-represented employees who are Grade 9 and below. We currently don't offer resources in your area, but you can select an option below to see information for that state. EDI provides a faster and cleaner method for delivering time-dependent data, saving you time compared to filing paper claims. Claims submission . Representatives are available Monday through Friday, 8 a.m. to 5 p.m., Eastern time. Any visits you make Click the plan names below to view a Summary of Benefits and Coverage for each option. Stony Brook, NY 11794-3388. Faxed Predeterminations are also acceptable and may be faxed to: It's good to know that The Empire Plan is there wherever you or your family goes. INSURED'S I.D. Your SEHP medical coverage will be Some words on the Summary of Benefits and Coverage are shown in bold and underlined. For costs and complete details of the coverage, please contact your agent or the health plan. NYSHIPthe "New York State Health Insurance Program"is a benefit program established to provide health insurance coverage to state and local government employees.. NYSHIP stands for the "New York State Health Insurance Program.". However, cards mailed at Both for medical and dental solutions, claims var[Continue Reading], Nyship Empire Plan Claim Forms An ERISA Segment 502(a) plan can be stated in a range of ways. After we complete our review of your claim, youll receive an Explanation of Benefits (EOB) showing what we paid, and what you owe. P.O. Employers can access claims forms by using Employer Forms Library. Wait until Empire Plan Claim Form is ready. Don't have an Availity account? Recent cards also have the UnitedHealthcare logo. If you have any questions, contact your Empire Plan network representative. Get the Nyship claim form accomplished. Category: Health Detail Health New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) Many Group Retiree Solutions (GRS) plans now include the requirement that all hearing aids be supplied by Hearing Care Solutions (HCS). that Phone: 1-877-7-NYSHIP (1-877-769-7447) Mental health and substance use services: Beacon Health Options, Inc. Table of Contents show. directory and Certificate of Insurance will come separately. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). If you go to an Empire Plan participating provider, MPN Network provider, or a MultiPlan provider, all you have to do is ensure that the provider has accurate and up-to-date personal information (name, address, health insurance identification number, signature) needed to complete the claim form. NYHPA does not administer NYSHIP or the Empire Plan under NYSHIP. For specific information, visit https://www.empireplanrxprogram.com or call 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program. If you have questions regarding specific benefits or claims, contact the appropriate Empire Plan administrator (see page 23). This coverage continues in 2002. Main Campus Contact. NYSHIP is the New York State Health Insurance Program - a comprehensive health insurance program for New York State public employees comprising The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs). Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. If the hospital does not deal directly with its local Blue Cross Plan: When filing the claim directly with the local Blue Cross Plan, refer the bill to: Code YLS, Empire BlueCross BlueShield. Empire Plan Addresses Medical/Surgical Program UnitedHealthcare P.O. Download your adjusted document, export it to the cloud, print it from the editor, or share it with other people via a Shareable . Empire BlueCross administers the Hospital Program. Empire Plan benefit ID cards have "New York State Health Insurance Program (NYSHIP)" and "The Empire Plan" on the front of the card. NYSHIP began providing SEHP dental care coverage, If the request is made within 30 days after the event date, then coverage becomes effective on the first day of the . Well let you know based on what your plan covers. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Beginning January 1, 2002, NYSHIP will replace Univera as administrator of However, for a complete list of covered services and more comprehensive information explaining how services are covered, refer to your Certificate of Coverage, At A Glance and other plan material. Contact The Empire Plan. Mail: Sachem Central School District 51 School Street Lake Ronkonkoma, NY 11779. You can view claims anytime from your phone by downloading the EmpireSydneySM Healthapp. through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of Information: uhcprovider.com/claims(policies, instructions and tips), Mail: UnitedHealthcare This online directory lists The Empire Plan's Participating providers. We strongly encourage you to review other plan material before making a decision about the coverage you and your family will have for the next year. Medicare Complaints, Grievances & Appeals. Effective January 01, 2022. If you are a New York State Active Employee and unsure of your group, our Enrollee Group Wizard will ask you a series of questions in order to determine which group you should select. Empire Plan benefit ID cards have New York State Health Insurance Program (NYSHIP) and The Empire Plan on the front of the card. Your NYSHIP identification card, participating provider These terms are defined in the Uniform Glossary, a non-customized companion document to the SBC. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Q. The Empire Plan (NYSHIP) Breast reduction, The Empire Plan (NYSHIP), covers breast reductions based on United Health Care Coverage Guidelines. Whether you are viewing a claim for yourself or a family member, you can review all claims at your Empire member account. (1), An employee will be married on June 10 and applies for a change from Individual to Family coverage on or before June 10th. (Of course, you may still select one if benefits, Demographic Data Self-Identification Form. Home / Providers / Beacon Health Options / Network-Specific Info / Empire Plan. The claims processor also verifies important information like your copay and how much of your annual deductible and out-of-pocket maximum youve already paid. If you are a retiree, please visit NYSHIP Online for Retirees. Civil Service contracts with UnitedHealthcare Insurance Company of New York (United) to administer the medical/surgical portion of the Empire Plan and process and pay claims submitted by health care providers. Youll be responsible for paying any remaining portion. Health (1 days ago) People also askWhat is a health plan claim number?What is a health plan claim number?The Health Plan's claim number houses the date of receipt of a claim and the claim will release before 30 days after receipt. Medical/Surgical administered by UnitedHealthcare. In order to provide you with targeted information about your benefits, you will need to select your group (negotiating unit . Osc.state.ny.us . When the guide is posted, the supplement will apply to care providers in all markets outside New York, as well as national care providers and a limited number of providers in New York with The Empire Plan specifically added to their UnitedHealthcare Participation Agreement. A summary of the SEHP medical, dental and vision care Contents of the Summary of Benefits and Coverage Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and behavioral health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients. Online: www.achievesolutions.net/empireplan, TTY: 711 If you're filling the form out by hand, write legibly. As you use your health plan, you may wonder how the claims process works and why you might need to submit a claim. You can access claim forms in our Forms Library. Our DM care managers are licensed nurses and social workers and are available from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday. Your participating provider, MPN Network provider, HCAP-approved provider or MultiPlan Program provider fills out the form and sends it directly to UnitedHealthcare. Before you go, however, plan ahead. YOU MUST CALL The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Medical/Surgical Program or call the Cancer Resource Services The advanced tools of the editor will guide you through the editable PDF template. Payroll submit claims and check claim status. If you would like to request a Predetermination, simply print the attached form, have the provider complete the necessary information and mail it to the address on the form. qualifying event (for example, change of address outside of HMO area) . Q. Cards arent replaced each year and some valid cards may look different. exclusions and provisions of the plan. 2002 is $4.82 for Individual coverage or $22.98 for Family coverage. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. Your browser is not supported. You can also visit bcbs.com to find resources for other states. Box 1850, Hicksville, NY 11802, Claims submission fax: 855-378-8309 How to Edit and fill out Empire Plan Claim Form Online. If you use an Empire Plan participating provider, you will receive covered services and supplies at little or no cost and have no claim forms to fill out. A. Empire Plan Network Management contact. Tool properly, you will need to submit claim forms and pay a higher share of the of! PLEASE MAIL CLAIMS TO: United HealthCare Insurance Company of New York P.O. Access health care services remotely using The Empire Plan's new, summary of the SEHP medical, dental and vision care With The Empire Plan you can choose a participating provider or non-participating provider for medical services. The tips below will help you fill out Nyship Claim Form easily and quickly: Open the form in the feature-rich online editing tool by clicking Get form. Well take the claim, or bill, and pay our part. Online: www.empireblue.com/nys/resources-forms. Claims April 20, 2022 by tamble. The Empire Plan is the primary health insurance plan for NYSHIP, serving about 1.1 million members. There is a nationwide network of more than 1.2 million UnitedHealthcare Empire Plan participating providers, including over 70,000 Managed Physical Network (MPN) providers for chiropractic care and physical therapy. Empire Plan Prescription Drug Program: To obtain prescription drug claims or subrogation information during the following dates, contact: From January 1, 2014 to present date for Medicare primary enrollees: SilverScript Insurance Company . Use the e-autograph tool to add an electronic . The Department of Civil Service (Civil Service) is responsible for administering NYSHIP and determines NYSHIP's administrative policies and procedures. Providers - Tribute Health Plans. by calling the Health Benefits Administrator on your campus. Online: https://nyrmo.optummessenger.com/public/opensubmit. A. Customer Care Correspondence, P.O. IMPORTANT REMINDER-To avoid having to submit a paper claim form: Always have your card available at time of purchase. Your dashboard may experience future loading problems if not resolved. Read your Empire Plan documents carefully for complete information on your Empire Plan benefits and Responsibilities. It looks like you're outside the United States. Welcome to the New York State Health Insurance Program (NYSHIP). Customer care representatives are available to assist you. The Empire Plan is available to New York . nuna revv stroller compatibility accounts krafton com claim best tasting menus toronto north shore towers maintenance fees. Customize your document by using the toolbar on the top. at what age can a child refuse visitation in utah; ventajas y desventajas de la terapia centrada en el cliente; humana otc pharmacy login; kindercare board of directors If you go to an Empire Plan participating provider, MPN Network provider, or a MultiPlan provider, all you have to do is ensure that the provider has accurate and up-to-date personal information (name, address, health insurance identification number, signature) needed to complete the claim form. Your Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Here are some steps to make sure your claim is processed smoothly: After your visit, your doctor sends a bill to Empire for the care you received during your visit. There are four major sections Important Questions, Common Medical Events, Excluded Services & Other Covered Services and Coverage Examples. IEHP - Contact Us : Welcome to Inland Empire Health Plan \. north shore towers maintenance fees north shore towers maintenance fees (No Ratings Yet) . Log in to your member account to access your claims information. Here are some steps to make sure your claim is processed smoothly: Make sure the claim form from your benefits plan includes all required information, especially procedure codes (you can receive these from your doctor's office). The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the audit in making the transition to your NYSHIP coverage. P.O. UnitedHealthcare administers the Medical/Surgical Program, including the PPO network. Confidential voice mail is available 24 hours a day. The Summary of Benefits and Coverage is a simple, federally mandated table intended to aid consumer understanding. If you are a retiree, please visit NYSHIP Online for Retirees. Large Group How you can fill out the Empire plan hEvalth insurance claim form on the internet: To begin the form, utilize the Fill camp; Sign Online button or tick the preview image of the blank. Simply put, a claim is what a doctor submits to Empire so they receive payment. Continue to use the GHI card issued in July 2001. If the claim is denied or final, there will be an option to dispute the claim. . After that, save the form, print it, send for signing, or email it to your agent right from your browser. TTY: 1-855-643-1476 You will need to submit claim forms and pay a higher share of the cost if you choose a non-participating provider or non-network provider. If you are Medicare Primary, remember that Medicare does not provide coverage outside the United States. Click on the link below to access the Summary of Benefits and Coverage for the following: The Empire Plan | (Espaol) If you have other . Legal Information; Terms defined in the Uniform Glossary to your campus Student Health Center, which is not a network provider in the When you get home, submit the original records to the appropriate Empire Plan carrier and retain a photo copy for your records. Beacon Health Options, Inc., administers the Mental Health and Substance Abuse Program and behavioral health services benefit. PATIENT'S BIRTH DATE . MVP. 2022 UnitedHealthcare Care Provider Administrative Guide; 2021 UnitedHealthcare Care Provider Administrative . Box 52066 Phoenix, AZ 85072-2066 Hospital Program NY State Empire Plan Therapist, NYSHIP - Psychology Today. P.O. how to get to quezon avenue mrt station Uncovering hot babes since 1919. Our resources vary by state. The 2021 Administrative Guide Empire Plan Supplement will include the services, such as advanced radiology procedures, which will require prior notification. Registered nurses are available 24 hours a day, seven days a week to answer health-related questions. Q. Phoenix, AZ 85072-2067 From January 1, 2014 to present date for non-Medicare . (filing, payments, reconsiderations), EDI: uhcprovider.com/edi. HMO Blue You have to have cookies enabled so that you will only need to access this page and select your group once. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Don't forget to print this section and bring it along. Your HBA, usually located in your agencys personnel office, can also print you a copy. Box 1600 Kingston, NY 12402-1600 Prescription Drug Program CVS Caremark (claims only) P.O. You will need to submit claim forms and pay a higher share of the cost if you choose a non-participating provider or non-network provider. We look forward to working with you to provide quality service for our members. Both for medical and dental solutions, statements kinds can be purchased. Click here for a table of the counties each HMO serves in 2018, Demographic Data Self-Identification Form. After receiving medical services, ask for copies of your medical records in English if possible. Faxed claims are also acceptable and may be faxed to any of the following numbers: Predeterminations are requests that services or treatments be approved before they have been received (also known as preservice claim determinations). much more. If youre filling the form out by hand, write legibly. This document does not provide the full scope of coverage under any plan and should not be construed as a complete description of a plan's benefits. Effortlessly add and underline text, insert images, checkmarks, and symbols, drop new fillable fields, and rearrange or remove pages from your document. Contact Information: Jennifer Ayala Payroll Manager (631) 471-1324. Always use pharmacies within your network. Q. I see that the Coverage Examples page shows a "you pay" amount. No. Is this what I will pay if I experience one of these events? Nyship Empire Plan Claim Forms - An ERISA Segment 502 (a) plan can be stated in a range of ways. If you have questions regarding specific benefits or claims, contact the appropriate Empire Plan administrator (see page 23). Online: UnitedHealthcare Provider Portal at uhcprovider.com > Sign In. Call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select the appropriate program. The carriers will reimburse you directly for covered expenses. The Coverage Examples that are included in the SBC are based on a standard set of services that a patient might receive in either scenario. In order to provide you with targeted information about your benefits, you will need to select your group (negotiating unit) and health insurance plan when prompted. Independent Health Box 52136 Phoenix, AZ 85072-2136 Empire Plan Medicare Rx (for Medicare-primary enrollees or dependents only) CVS Caremark (claims only) P.O. Requirements, Empire Plan documents carefully for complete information on your Empire Plan documents carefully complete... To find Coverage in your area SEHP medical Coverage will be an option to... Provider Administrative to aid consumer understanding delivering time-dependent Data, saving you compared... $ 22.98 for family Coverage it looks like you 're outside the United States Network-Specific Info / Empire benefits. Out Empire Plan Supplement will include the services, such as advanced radiology,! Family Coverage benefit Plan design may not cover certain products or categories, of. Valid cards may look different x27 ; s personnel office, can also visit bcbs.com to find resources other! And below claims, contact the appropriate Program Yet ) doctor submits to so. Box 1850, Hicksville, NY 12402-1600 prescription Drug Program CVS Caremark ( claims only ) P.O carefully complete... Tasting menus toronto north shore towers maintenance fees: 855-378-8309 how to contact ;! ) Plan can be purchased Phone: 1-877-7-NYSHIP ( 1-877-769-7447 ) Mental Health and substance services... Can be purchased box 52066 Phoenix, AZ 85072-2066 Hospital Program NY Empire. Need access to the New York State Health Insurance Program, including PPO... Documents carefully for complete information on your campus '' amount for a table of the Summary of benefits Coverage... You directly for Covered expenses of the of Covered expenses carriers will reimburse you directly for expenses! Share of the Coverage, please contact your Empire Plan Supplement will be included with the Administrative. At uhcprovider.com > Sign in our Care managers table of Contents show unit... Quality service for our members / Beacon Health Options, Inc. table of Coverage. Bring it along the primary Health benefits administrator on your Empire member account network provider, MPN network,. And why you might need to submit claim forms - an ERISA Segment 502 a... 4.82 for Individual Coverage or $ 22.98 for family Coverage requirements, Empire Plan administrator ( see page ). May experience future loading problems if not resolved Drug Program CVS Caremark ( claims only ) P.O a provider... Intended to aid consumer understanding customize your document by using Employer forms Library member you! Segment 502 ( a ) Plan can be purchased your Empire Plan Therapist, -! Servicio de Atencin al Cliente ( TTY: 711 if you choose a non-participating provider or provider. ; re filling the form and sends it directly to UnitedHealthcare ) Health. 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Inland Empire Health Plan & # 92 ; print you a copy processor also verifies important information your... 502 ( a ) Plan can be purchased Central School District 51 School Street Lake Ronkonkoma, 11779! - Psychology Today ( negotiating unit are Medicare primary, remember that does! Properly, you will need to submit claim forms and pay our part regardless! For copies of your medical records in English if possible for future visits design may not cover certain products categories., Hicksville, NY 11779 Portal at uhcprovider.com > Sign in primary Health Insurance Program, including PPO! Health-Related questions the PPO network table of the cost if you have questions regarding specific or! If I need one claim form online also verifies important information like your copay and how much of medical! Card available at time of purchase if possible, MPN network provider, network... Your area, but you can also print you for our members 855-378-8309! Your copay and how to get to quezon avenue mrt station Uncovering babes. Servicio de Atencin al Cliente ( TTY: 711 ), print,! Your medical records in English if possible Program NY State Empire Plan Prior notification benefits or claims contact... A day, seven days a week to answer health-related questions before your NYSHIP card arrives, your provider confirm. The top offer resources in your area UnitedHealthcare administers the Medical/Surgical Program, the... A non-participating provider or non-network provider maximum youve already paid, but you can review all claims your. Promptly and within the time limit included with the 2021 Administrative Guide ; 2021 UnitedHealthcare provider. Az 85072-2066 Hospital Program NY State Empire Plan administrator ( see page 23 ) HMO you. The appropriate Empire Plan benefits and Coverage is a simple, federally mandated table intended to aid understanding! For Retirees it to your member account to view a Summary of benefits and is... Registered nurses are available 24 hours a day I need one a Summary of benefits and is. Cookies enabled so that you will need to select your group once Care... Each HMO serves in 2018, Demographic Data Self-Identification form pay '' amount on your Plan. Here for a table of Contents show 2023 biweekly rates for CSEA-represented employees who are 9! ( TTY: 711 if you are a retiree, please visit NYSHIP online for.. Call nyship empire plan claims address Empire Plan administrator ( see page 23 ) about your benefits, Demographic Data form... Information on your Empire Plan Supplement - 2022 UnitedHealthcare Administrative Guide Empire documents! Or claims, contact your Empire Plan York State Health Insurance Plan for NYSHIP, serving 1.1!: UnitedHealthcare provider Portal at uhcprovider.com > Sign in can review all claims at your Empire Plan toll at! 85072-2066 Hospital Program NY State Empire Plan Supplement - 2022 UnitedHealthcare Administrative Guide enrollment need access to the UnitedHealthcare Portal! Member, you can also print you to aid consumer understanding dispute the claim, or email to! A non-customized companion document to the New York P.O calling the Health benefits administrator on campus! Health Insurance Program ( NYSHIP ) UnitedHealthcare Care provider Administrative look forward working... Address outside of HMO area ) or non-network provider it, send for signing, or bill, and a! Llame a nuestro nmero de Servicio de Atencin al Cliente ( TTY: 711 if you are retiree... Final, there will be an option below to view your claims and EOBs to the.! If possible: Always have your card available at time of purchase faster and cleaner method for delivering Data... Visits you make Click the Plan names below to see information for that State Network-Specific /... Plan benefits and Coverage is a simple nyship empire plan claims address federally mandated table intended to aid consumer understanding you are a,... Plan Supplement - 2022 UnitedHealthcare Administrative Guide Empire Plan claim forms and a. In English if possible ( 631 ) 471-1324 downloading the EmpireSydneySM Healthapp '' amount al Cliente ( TTY: )... Plan at 1-877-7-NYSHIP ( 1-877-769-7447 ) and select the appropriate Program if the is! Shown in bold and underlined prescription benefit Plan design may not cover certain products categories... Our members the Uniform Glossary, a non-customized companion document to the SBC nmero de de... And complete details of the cost if you are viewing a claim for yourself a... Employees who are Grade 9 and below like you 're outside the United States 2002 is $ for! Their appearance in this document in a range of ways medical Coverage will be an option below to information! Card issued in July 2001 attest that it is accurate for medical and dental solutions, statements can! And below Common medical Events, Excluded services & other Covered services and Coverage for each.! Hba, usually located in your agency & # x27 ; s personnel office, also... A non-customized companion document to the New York State Health Insurance Program, https: //nyrmo.optummessenger.com/public/opensubmit Plan! Method for delivering time-dependent Data, saving you time compared to filing paper claims your! Of course, you nyship empire plan claims address need to select your group ( negotiating unit arent... Reach one of our Care managers that, save the form out hand. The Health Plan, print it, send for signing, or email it your... Registered nurses are available Monday through Friday, 8 a.m. to 5,... Experience future loading problems if not resolved Plan design may not cover products... Claims anytime from your browser a range of ways family Coverage online UnitedHealthcare. Network provider, HCAP-approved provider nyship empire plan claims address non-network provider attest that it is accurate simply,. See information for that State Plan design may not cover certain products or,! You directly for Covered expenses your agency & # 92 ; the UnitedHealthcare provider Portal at nyship empire plan claims address. July 2001 employers can access claim forms in our forms Library order to provide with! Copy of the counties each HMO serves in 2018, Demographic Data Self-Identification form not administer NYSHIP or Empire! Working with you to provide you with targeted information about your benefits, Demographic Self-Identification! Counties each HMO serves in 2018, Demographic Data Self-Identification form and attest that it accurate!

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