Member Materials

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

2019 Plan Documents

Annual Notice of Changes

Click below to download the full list of benefit changes for 2019.

  • 2019 Annual Notice of Changes [PDF, English]
  • 2019 Annual Notice of Changes [PDF, Portuguese] - Coming soon
  • 2019 Annual Notice of Changes [PDF, Spanish] - Coming soon

Provider/Pharmacy Directory

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

  • Provider/Pharmacy Directory [PDF, English]
  • Provider/Pharmacy Directory [PDF, Portuguese] - Coming soon
  • Provider/Pharmacy Directory [PDF, Spanish] - Coming soon

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.

  • Member Handbook [PDF, English]
  • Member Handbook [PDF, Portuguese] - Coming soon
  • Member Handbook [PDF, Spanish] - Coming soon

List of Covered Drugs (Formulary)

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

  • Formulary [PDF, English] 
  • Formulary [PDF, Portuguese] - Coming soon
  • Formulary [PDF, Spanish] - Coming soon

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.

  • Summary of Benefits [PDF, English]
  • Summary of Benefits [ PDF, Portuguese] - Coming soon
  • Summary of Benefits [PDF, Spanish] - Coming soon

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

2019 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  - Coming Soon

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 - Coming Soon

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

2018 Plan Documents

Annual Notice of Changes

Click below to download the full list of benefit changes for 2018.

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. The formulary may change at any time. You will receive notice when necessary

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

2018 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 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.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 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 holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

ATENCIÓN: Si usted habla Español, servicios de asistencia con el idioma, de forma gratuita, están disponibles para usted. Llame a Servicios a los Miembros al 1-844-812-6896 (TTY 711), de 8 am a 8 pm, de lunes a viernes, de 8 am a 12 pm los Sábados. En las tardes de los Sábados, domingos y feriados, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día hábil. La llamada es gratuita.

ATENÇÃO: Se você fala Português, o idioma, os serviços de assistência gratuita, estão disponíveis para você. Os serviços de chamada em 1-844-812-6896 TTY (711), 8 am a 8 pm, de segunda a sexta-feira; 8 am a 12 pm no sábado. Nas tardes de sábado, domingos e feriados, você pode ser convidado a deixar uma mensagem. A sua chamada será devolvido no próximo dia útil. A ligação é gratuita.

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. 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 October 14, 2018, 9:55 am

H9576_WebMaterials CMS Approved 11/17/17