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Samples for the Evidence of Coverage (EOC) and Member Handbook

2018

2017

Information about the Sample EOCs and Member Handbooks

These samples are intended for use by health plans under contract with the Minnesota Department of Human Services (DHS). The models contain general information and do not include details specific to individual health plans.

Managed care organizations or MCOs (also called health plans) must comply with contractual requirements and applicable state and federal regulations regarding EOCs and Member Handbooks. Contracted MCOs use the Sample EOCs and Handbooks as a basis for their own EOCs and Handbooks. Each MCO is responsible for including MCO specific information, including but not limited to, referral and service authorization requirements. MCOs must obtain prior approval for their EOCs and EOC addenda from both the Minnesota Department of Human Services (DHS) and, for certain EOCs, from the Minnesota Department of Health (MDH). For the Minnesota Senior Health Options (MSHO) and Special Needs BasicCare (SNBC) for members who have the combined Medicare and Medicaid product, EOC and Member Handbook approval from the Centers for Medicare & Medicaid Services (CMS) is also required. MCOs should contact their designated DHS contract managers if they have questions about the DHS sample EOCs and Member Handbooks.

Please note that the format of the EOCs and Member Handbooks, including pagination, is the responsibility of the MCOs when creating their MCO-specific EOCs and Member Handbooks.

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