HomeFirst Member Rights Upon Disenrollment

HomeFirst 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 HomeFirst and do not wish to make a change, you do not need to take any action.

年度退保權利通知

儘管我們感激您成為我們的會員，但參保 HomeFirst 純屬自願。若您需要長期護理服務並且希望退出 HomeFirst，您必須透過 NY Medicaid Choice 選擇另一項計劃，以便繼續接受相關服務。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.

You may leave HomeFirst and join another health plan at any time during the first ninety (90) days of enrollment. If you do not leave within that timeframe, you must stay in HomeFirst for nine more months, unless you have a good reason (Good Cause). 「正當理由」範例包括：

• 您搬離我們的服務區域。
• 您、該計劃、您的縣社會服務部或紐約州衛生部一致同意您離開您的 Homefirst 計劃是最好的選擇。
• 您的當前居家護理提供者不再與我們的計劃合作。
• We have not been able to provide services to you as we are required to under our contract with the State.

If you qualify, you can change to another type of managed long-term care plan like Medicaid Advantage Plus (MAP) or Programs of All-Inclusive Care for the Elderly (PACE) at any time without good cause. 若要變更計劃：請致電 1-800-505-5678 聯絡紐約 Medicaid 醫療補助選擇。紐約 Medicaid 醫療補助選擇的顧問能夠幫助您更換保健計劃。

If you feel you no longer need managed long-term care services, 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。HomeFirst 還會將您的退保申請轉送到 LDSS 或 NY Medicaid Choice 以進行處理。

There are reasons, such as if you no longer reside in the plan’s service area, that HomeFirst can involuntarily disenroll you, or ask you to leave the Plan. For a complete list of these reasons and more information about the involuntary disenrollment process, please refer to your member handbook.

若您選擇從 HomeFirst 退保或非自願性地被 HomeFirst 退保，您的退保生效日期將為 LDSS 或 NY Medicaid Choice 處理您的申請後當月的最後一天。但是，若您的退保在當月 20 日之後處理，您的退保生效日期將為下個月的最後一天。

從您提交退保申請之時到您的退保生效日期，HomeFirst 將繼續為您提供您的承保福利。在退保日期後，我們還將針對不再受 HomeFirst 承保的替代服務提供所有必要的轉診。

Thank you again for choosing HomeFirst for your long-term care needs. If you have any questions or need assistance, please call Member Services at 1-877-771-1119 (TTY 711), Monday through Friday from 8:30 a.m. to 5:00 p.m.

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：

• 向殘障人士提供免費協助和服務，幫助他們與我們進行有效溝通，比如：

• • 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 1-877-771-1119 (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）

1-877-771-1119 (TTY: 711).

（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）