Member Materials

Everything you need to know about Neighborhood INTEGRITY (Medicare-Medicaid Plan) is just a click away.

2017 Plan Documents

Annual Notice of Changes

Click below to download the full list of benefit changes for 2017.

Provider/Pharmacy Directory

Click below to find a provider, specialist, hospital or pharmacy near you.

To see a list of our pharmacies, you can search our Pharmacy Locator

Member Handbook (Evidence of Coverage)

Click below to get detailed information about your coverage with Neighborhood INTEGRITY.

List of Covered Drugs (Formulary)

Click below to download the full list of covered drugs under this plan.

Click below for a list of Durable Medical Equipment Supplies limited at pharmacies. 

Summary of Benefits

Click below for a summary of benefits available under the Neighborhood INTEGRITY plan.

Multi-Language Insert

Click below for interpreter services available to you.

Sample ID Card

Click below to see a sample Neighborhood INTEGRITY member ID card

2017 Member Forms

Appointment of Representative (AOR) Form

This form is used to appoint an individual to act as your representative. You can name another person to ask for a coverage decision or make an appeal. If you want a friend, relative, lawyer or another person to be your representative, this form will give the person permission to act for you. You must give us a copy of the signed form.

Request for Drug Determination Form  

Use this form to request a decision on a request for a Part D drug with Neighborhood INTEGRITY.

Enrollee Grievance Request Form

Use this form if you would like to notify Neighborhood of a complaint or grievance. 

Enrollee Appeal Request Form

Use this form to file an appeal of an adverse decision.

Request for Redetermination of Part D Denial Form  

Use this form if a Part D drug has been denied and you believe it should be covered.

Member Reimbursement Form for Part D Drugs 

Use this form to request reimbursement if you paid the full cost of a prescription from one of our Network pharmacies. 

Have questions?

Please call us at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free. 

Neighborhood Health Plan of Rhode Island is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.

This information is available for free in other languages. Please call our Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro Departamento de Servicios para Miembros al 1-844-812-6896 (TTY 711) de 8 am a 8 pm, lunes-viernes; sábados de 8 am a 12 pm. Los sábados por la tarde, domingos y días festivos federales, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día laborable. La llamada es gratuita.

Estas informações estão disponíveis gratuitamente noutros idiomas. Por favor telefone para os Serviços dos Membros em 1-844-812-6896 (TTY 711), das 8 às 20 horas, de Segunda a Sexta-feira; e das 8 às 12 (meio-dia) aos Sábados. Nos Sábados à tarde, Domingos e feriados federais, poderá ser-lhe pedido que deixe uma mensagem. A sua chamada será respondida no próximo dia útil. Esta chamada é grátis.

Our plan can also give you materials in Spanish and Portuguese and in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.

Last Updated March 31, 2017, 2:18 pm

H9576_WebMaterials CMS Approved 9/13/16