(English source text)

 

Out-of Network Treatment
The Intracorp MPN has providers for the entire state of California.  Ou may treat with a doctor of your choice outside of the network if:

• You are authorized to temporarily work or travel outside the state of California.
• You are a former employee whose employer has ongoing workers’ compensation obligations and are permanently residing outside the MPN geographical service area.
• You are an injured employee who decides to temporarily reside outside of the geographic service area during recovery.

• You are in a situation where a particular specialist is not available in you area, please contact REM, LTD.  You may have the right to see a specialist outside of the Intracorp MPN in this case.

 

Terminated MPN Providers and Continuity of Care

• If your provider terminates from the MPN, you employer will advise you on your options for continued treatment as approved under Intracorp’s Continuity of Care Plan.  In some instances, the terminated provider may continue to treat you through Intracorp’s Continuity of Care Plan.  A copy of the Continuity of Care Plan is included with this letter and is also available upon request.  Contact your supervisor or REM, LTD for questions or advice on your options.

Transfer of Care

• If you already have a workers’ compensation claim at the time that you receive this notice, contact your supervisor or REM, LTD.  You may qualify to continue treatment with your current provider under Intracorp’s Transfer of Care Plan.  A copy of the Transfer of Care Plan is included with this letter and is also available upon request.  Contact your supervisor or the REM, LTD for questions or advice on your options.

____________________________________________________________________________________

[Traditional Chinese target translation]

 

網絡體系外治療

Intracorp MPN 在加州各地均有服務商。下列情況下，您可以選擇網絡體系外的醫生接受治療：

• 您獲准暫時在加州以外工作或旅行。
• 您的前任雇主負有員工補償義務，且長期居住在 MPN 的服務地域之外。
• 您是受傷的員工，並決定在康復期內暫時居住在服務地域外。

• 您所在的地區無法找到某類專科醫生，請聯繫 REM，LTD。在此情況下，您可能有權找 Intracorp MPN 之外的專科醫生就診。

 

MPN 服務商的終止與治療的連續性

• 如果您的服務商退出 MPN，您的雇主將告知您 Intracorp 的“治療連續性計劃”爲您提供了哪些繼續治療的選擇。在一些情況下，已退出的服務商可通過 Intracorp 的“治療連續性計劃”繼續爲您治療。這封信附有“治療連續性計劃”的副本，您也可以另行索取。如果您對於各種選擇懷有疑問或需要建議，請聯繫您的主管或 REM，LTD。

 

轉診

• 如果您在收到本通知時已經提出了工傷索賠，請與您的主管或 REM，LTD 聯繫。您可能符合相關條件，可以按照 Intracorp 的“轉診計劃”繼續接受當前服務商的治療。這封信附有“轉診計劃”的副本，您也可以另行索取。如果您對於各種選擇懷有疑問或需要建議，請聯繫您的主管或 REM，LTD。