2026 Annual Notice to Maryland Physicians Care Members

Your Rights and Responsibilities

You have rights as a member. You will not be treated differently for using your rights. It is important to understand your rights and responsibilities.

You will find your rights:

• In the Member Handbook
• On the MPC website, https://www.marylandphysicianscare.com/rights-and-responsibilities/

If you do not have internet access or would like a paper copy, please call Member Services at 1-800-953-8854.

Quality Improvement Programs

We check the care you receive to make sure it is high quality. Our Quality Improvement Program helps make sure you have:

• Easy access to care.
• Programs that meet your needs.
• Help with any ongoing health problems
• Support when you are sick or leave the hospital
• Good experiences with your doctors and health plan

Some things we do:

• Send postcards or newsletters with health tips
• Review the care you get
• Remind you about checkups and preventive care
• Track how long it takes to get an appointment
• Make sure calls are answered quickly
• Make sure doctors get the information they need

This is not a complete list of everything we do. To learn more, visit our website at
https://www.marylandphysicianscare.com/for-members/benefits/quality-improvement.html. Or you can call us at 800-953-8854. We can also give you a written copy of this information.

Protecting Your Health Information

We work to keep your health information safe. We do this by:

• Following rules on how we use your information
• Training staff to protect your information
• Keeping records in safe places
• Only allowing the right people to see your information

Your Privacy Rights

Your information is used to give care, process payment, and run the health plan, or Treatment, Payment, and Health Plan Operations (TPO). You have rights when it comes to your health information.

• You can say yes or no to how your information is used.
• We will not use your information for anything other than TPO without your permission.
• You can ask us to use your information in a different way
• You must send us a request, and we will follow your choice. All requests must be in writing. You may cancel your request at any time. You may send your written request to:
  Compliance Manager
  Maryland Physicians Care
  1201 Winterson Rd
  Suite 400
  Linthicum Heights, MD 21090

You can view the privacy policy on our website at: https://www.marylandphysicianscare.com/privacy-policy/.

Approving Medically Necessary Care

We want to make sure our members get the right care at the right time. Our Utilization Management Program reviews how services are used. This helps us make sure care is not over- or underused.
We follow these rules:

• Decisions are based only on what care you need and what is covered
• We do not reward providers for denying care
• We do not give rewards for using fewer services

Our staff uses medical guidelines to make decisions. You can learn more at
https://www.marylandphysicianscare.com/providers/resources/. You can also call Member Services at 1-800-953-8854 for
help

Benefit or Copayment Questions

You can learn about your benefits, covered services, and costs:

• In the Member Handbook
• On our website at: https://www.marylandphysicianscare.com/members/benefits/medical-coverage/.

Make sure you know about which services are covered, and which are not. If you do not have internet access or would like a paper copy, please call Member Services at 1-800-953-8854.

Population Health Management

MPC offers programs to help you stay healthy. These programs are optional. You can join or leave at any time. Your
benefits will not change whether you join these programs or not.
Our Care Management Department is here to help you:

• Understand your health condition
• Manage your health problems
• Plan your care

Care advisors and care coordinators can help Monday through Friday during normal business hours.
A care advisor may:

• Help you plan your care
• Help you get services
• Track the care you receive

To learn more or join: call 1-800-953-8854 or email mpcsnc@mpcmedicaid.com
You can also find tools and tips here: https://www.marylandphysicianscare.com/members/health-and-wellness/

Pharmacy

If you or your child needs medicine, we can help. We have a list of approved medicines (called a formulary). Your doctor will choose the best option for you. This list includes generic and brand-name medicines. It also includes rules on how much you can get. Always ask your doctor if a generic medicine will work for you.

The formulary is updated every month. To learn more, visit:
https://www.marylandphysicianscare.com/members/benefits/approved-medications/

If you need help or would like this information mailed to you, please call Member Services at 1-800-953-8854

If You Receive a Bill from your Provider

You should not have to pay for covered services. MPC or your other insurance will pay for these services. Providers should not bill you for covered services or the difference between what MPC pays and what they charge.
If you get a bill from one of our providers, call Member Services at 1-800-953-8854.

Choosing Care

Your Primary Care Provider (PCP) is your main doctor. Call your PCP first for most health needs. If you need to see a specialist, your PCP can refer for you or you can find one yourself. You can visit the MPC’s online provider directory at https://www.marylandphysicianscare.com/find-a-provider/ or call Member Services at 1-800-953-8854.

Some specialty services do not need prior approval. We call this self-referral. You can go to a specialist for:

• Emergency care
• Eye exams
• Routine and preventive care from an OB/GYN
• Routine family planning services
• First visit with a physical therapist (you must get permission from MPC for follow-up visits)

Primary Mental Health Services

Basic mental health services are covered by MPC. You can get mental health services from your PCP or another provider in the network.

If you need more than basic mental health care, your PCP can refer you. You can also call the Public Behavioral Health System at 800-888-1965.

After‐Hours Care and Urgent Care

If you or your child gets sick after hours or on weekends, call your PCP’s office. Your PCP’s office will have an answering machine that will tell you what to do. The PCP may also call you back to tell you what to do. If you call at night, give your PCP time to get back to you.

MPC members can use the MyVirtualMPC app to talk to a doctor 24 hours, 7 days a week. For more information, visit: https://www.marylandphysicianscare.com/members/virtual-doctor-visits/.

If it is an emergency, you should ALWAYS call 911 or go to the nearest emergency room.

Emergency Care

If you are unsure, it is an emergency, call your PCP. An emergency is a serious health problem that needs care right away. This may include:

• Bleeding that will not stop
• Difficulty breathing
• Seizures
• Broken bones
• Medicine or drug overdose
• Severe burns
• Chest pains
• Not able to move
• Suicide attempts
• Choking
• Passing out (blackouts)
• Throwing up blood
• Danger of losing limb or life
• Poisoning

What to Do in an Emergency:
If you are having an emergency:

• Call 911 or go to the nearest hospital.
• You do not need pre-approval if you are out of network.
• You do not need pre-approval for emergency transportation to the hospital.

IMPORTANT: Only call 911 or go to the hospital emergency room when you have a true emergency.
If you need routine care or after-hours care, contact your PCP. Their number is on your MPC ID card. If your PCP is unavailable, you can also receive urgent care by searching the MPC Find a Provider site and locating a network urgent care center.

MPC also offers the MyVirtualMPC app for access to a doctor 24 hours, 7 days a week. Click here for more information: https://www.marylandphysicianscare.com/members/virtual-doctor-visits/.

Selecting a PCP and/or Changing a PCP

If you do not pick a PCP, MPC will choose one for you. You can choose a PCP from the provider directory at
https://www.marylandphysicianscare.com/find-a-provider/. This directory provides the name, address, phone number, specialty, board certification status, where they went to medical school attended and much more information about the doctor.

If you do not have internet access or would like a paper copy, please call Member Services at 1-800-953-8854.

Advanced Directives

MPC can help members age 18 and over make an Advance Directive. An Advanced Directive is a written plan for your healthcare wishes. To learn more, visit: https://www.marylandphysicianscare.com/members/advance-directives/.

New Technology for Medical Procedures

MPC always wants you to get safe, up-to-date, high-quality care. A team of doctors reviews new technologies and treatments. They decide if these should be covered services.

While a new technology or treatment is being studied, it is not covered. Before covering something new, we will:

• Learn what it is used for
• Review medical studies
• See how it can help members
• Set rules for when and how to use it

Out‐of‐Service Area Care When Away from Home

MPC covers care in Maryland only. When you are out of state,or your covered network, regular care for you or your child is not covered. Only emergency care is covered. If you are out of state or out of network and you or your child needs care, call your doctor. Your doctor’s phone number is on your MPC ID card. You can also call Member Services at 1-800-953-8854.

If it is an emergency:

• Call 911 or go to the nearest emergency room
• Bring your MPC ID card

If you or your child is admitted to the hospital, ask the hospital to call Member Services Department at 1-800-953-8854.

Member Complaints

We take member complaints and appealsseriously. If you are not happy, please let us know. Your feedback helps us improve. To file a complaint or appeal, click: https://www.marylandphysicianscare.com/member-complaints-grievances-andappeals/.

If you want a Member Advocate to help you, contact us:
Call: 1-800-953-8854
Write to us at:
Maryland Physicians Care MCO
Attn: Grievance and Appeals
P.O. Box 893
Portland, ME 04104

When you contact us, tell us:

• What happened
• The date it happened
• Names of people involved
• Your name, your child’s name, and your member ID number

You can get a second opinion at no cost. When a doctor says you need surgery or other treatment, you can talk with another doctor. This is called a second opinion. Your primary care doctor can recommend a provider. You can also call Member Services at 1-800-953-8854.

Out‐of‐Network Services

MPC has many doctors and services in our network. Sometimes you may need care outside the network. Out-of-network care must be approved first. This does not apply to family planning or emergencies. If approved, we will cover these services until they are available in our network. If you have questions, please call Member Services at 1-800-953-8854 or visit: https://www.marylandphysicianscare.com/members/benefits/medical-coverage/.

Nondiscrimination Notice

MPC follows federal civil rights laws. We do not treat people differently because of: race, ethnicity, color, national origin, age, disability, language, gender, or sexual orientation. MPC does not exclude people or treat them differently because of race, ethnicity, color, national origin, age, disability, language, gender, or sexual orientation.

Read the full notice, visit: https://www.marylandphysicianscare.com/wpcontent/uploads/2024/10/Final_MPCNonDiscriminationAccessNotice-2024_1.pdf

Limited English Proficiency (TTD/TTY) Services

We can help if you:

• Have trouble seeing or hearing
• Do not speak or know English well

These services are free. We offer:

• Phone interpreters
• Written translations of important information

For more information, call Member Services at 1-800-953-8854. TTY users can call 1-800-735-2258.

Language Accessibility Statement
If you do not speak English, language assistance services, free of charge, are available to you.
Call: 1-800-953-8854 (TTY: 1-800-735-2258)

Español / Spanish
Hay ayuda disponible en su idioma: 1-800-953-8854 (TTY: 1-800-735-2258). Estos servicios están disponibles gratis.

አማርኛ / Amharic
እገዛ በ ቋንቋዎ ማግኘት ይችላሉ፦: 1-800-953-8854 (TTY: 1-800-735-2258) ። እነዚህ አገልግሎቶች ያለክፍያ የሚገኙ ነጻ ናቸው

العربیة / Arabic
رقم 13464-463-877-1 – ملحوظة :إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان .اتصل برقم
(TTY: 1-800-735-2258) :والبكم الصم ھ

中文 / Chinese
用您的语言为您提供帮助：1-800-953-8854 (TTY: 1-800-735-2258)。 这些服务都是免费的

فارسی / Farsi
فارسی توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما این خدمات بھ
فراھم می باشد. با
1-800-953-8854 (TTY: 1-800-735-2258) .تماس بگیرید

Français / French
Vous pouvez disposer d’une assistance dans votre langue : 1-800-953-8854 (TTY: 1-800-735-2258). Ces services sont disponibles pour gratuitement.

જરાતીુ / Gujarati
તમાર ભાષામા ં મદદ ઉપલબ્ધ છે: 1-800-953-8854 (ટટવાય: (TTY: 1-800-735-2258). સેવાઓ મફત ઉપલબ્ધ છે

kreyòl ayisyen / Haitian Creole
Gen èd ki disponib nan lang ou: 1-800-953-8854 (TTY: 1-800-735-2258). Sèvis sa yo disponib gratis.

Igbo
Enyemaka di na asusu gi: 1-800-953-8854 (TTY: 1-800-735-2258). Ọrụ ndị a dị na enweghi ugwo i ga akwu maka ya.

한국어/Korean
사용하시는 언어로 지원해드립니다: 1-800-953-8854 (TTY: 1-800-735-2258). 무료로 제공 됩니다

Português / Portuguese
A ajuda está disponível em seu idioma: 1-800-953-8854 (TTY: 1-800-735-2258). Estes serviços são oferecidos de graça.

Русский / Russian
Помощь доступна на вашем языке: 1-800-953-8854 (TTY: 1-800-735-2258). Эти услуги предоставляются бесплатно.

Tagalog
Makakakuha kayo ng tulong sa iyong wika: 1-800-953-8854 (TTY: 1-800-735-2258). Ang mga serbisyong ito ay libre.

اردو / Urdu
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال
1-800-953-8854 (TTY: 1-800-735-2258). کر

Tiếng Việt / Vietnamese
Hỗ trợ là có sẵn trong ngôn ngữ của quí vị 1-800-953-8854 (TTY: 1-800-735-2258). Những dịch vụ này có sẵn miễn phí.

Yorùbá / Yoruba
Ìrànlọ́wọ́ wà ní àrọ́wọ́tó ní èdè rẹ: 1-800-953-8854 (TTY: 1-800-735-2258). Awon ise yi wa fun o free.

Swahili
Usaidizi unapatikana katika lugha yako: 1-800-953-8854 (TTY: 1-800-735-2258). Huduma hizi zinapatikana bila malipo.

Nepali
मद्दत तपाईंको भाषामा उपलब्ध छ: 1-800-953-8854 (TTY: 1-800-735-2258)। यी सेवाहरू निःशुल्क उपलब्ध छन्।

Hindi
आपकी भाषा में सहायता उपलब्ध है: 1-800-953-8854 (TTY: 1-800-735-2258)। ये सेवाएँ निःशुल्क उपलब्ध हैं।