Rights and Responsibilities

Elderplan is proud to have you as a member and looks forward to caring for you long into the future. Each year, however, we are required to provide our members with the following disenrollment notice. If you are pleased with Elderplan and do not wish to make a change, you do not need to take any action.

年度退保權利通知

While we value your membership, enrollment in Elderplan is voluntary. If you require long-term care services and wish to leave Elderplan, you must choose another plan with NY Medicaid Choice to continue to receive your services. In order to receive long-term care services in your home, you must be enrolled in a Managed Long-Term Care plan. You may return to Medicaid Fee-for-Service without long-term care services in your home.

If you feel you no longer need managed long-term care services or wish to enroll in another Managed Long-Term Care Plan, please call Member Services or your Care Management Team. 您的護理經理將為您寄送退保申請的書面確認函。Elderplan will also forward your disenrollment request to the LDSS or NY Medicaid Choice for processing.

There are also reasons, such as you are no longer enrolled in Elderplan for your Medicare coverage, where Elderplan can involuntarily disenroll you or ask you to leave the plan. This could occur by you enrolling in another Medicare plan or by losing your Medicare coverage. For a complete list of these reasons and more information about the involuntary disenrollment process, please refer to your member handbook.

If you choose to disenroll from Elderplan, your effective date of disenrollment will be the last day of the month after LDSS or NY Medicaid Choice has processed your request. However, if your disenrollment is processed after the 20^th of the month, your effective date of disenrollment will be the last day of the following month.

From the time of your disenrollment request through your effective date of disenrollment, Elderplan will continue to provide your covered benefits to you. We will also make all necessary referrals for alternative services, no longer covered by Elderplan, after the disenrollment date.

For a complete list of disenrollment reasons and more information about the disenrollment process, please refer to your Member Handbook or go to www.elderplan.org.

Thank you again for choosing Elderplan. If you have any questions or need assistance, please call Member Services at 1-877-891-6447 (TTY 711), 8 a.m. – 8 p.m., 7 days a week.

Elderplan, Inc.

非歧視通知 — 歧視是違法的

Elderplan/Homefirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.Elderplan, Inc. 不會因種族、膚色、民族血統、年齡、殘障或性別將人拒之門外或給予他們不同待遇。Elderplan/HomeFirst：

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

• 向母語並非英語的人士提供免費語言服務，比如：

• • Qualified interpreters
  • Information written in other languages

如果您需要這些服務，請聯絡民權協調員。如果您認為 Elderplan/HomeFirst（長老計劃/第一家）因種族、膚色、民族血統、年齡、殘障或性別而未能提供這些服務或在其他方面存在歧視行為，您可向以下人員或機構提出申訴：

Civil Rights Coordinator
6323 7^th Ave
Brooklyn, NY, 11220

電話：1-877-326-9978, TTY 711
Fax: 1-718-759-3643

您可親自或透過郵件、電話或傳真的方式提出申訴。If you need help filing a grievance, Civil Rights Coordinator is available to help you.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW, Room 509F, HHH Building

Washington, D.C.  20201

1-800-368-1019，1-800-537-7697（語障專線）

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

多語言口譯服務

Attention:If you speak a non-English language or require assistance in ASL, language assistance services, free of charge, are available to you.Call 1-877-891-6447 (TTY:711).

（西班牙文）

（中文）

（俄文）

（法國克里奧爾文）

（韓文）

（義大利文）

（意第緒文）

（孟加拉文）

（波蘭文）

（阿拉伯文）

(French)

（菲律賓文）

（希臘文）

（阿爾巴尼亞文）

聯絡會員服務部

If you are an Elderplan Member and have questions or concerns, please don’t hesitate to contact Elderplan Member Services at 1-800-353-3765 [TTY: 711], 8 a.m. to 8 p.m., seven days a week.

For additional information on how to get in touch with us, visit our Member Services Page.

Want to become an Elderplan member?

Call our Enrollment Call Center at
1-866-360-1934 [TTY: 711]
8 a.m. to 8 p.m., 7 days a week or enroll online.