Everything you need to know about Neighborhood INTEGRITY (Medicare-Medicaid Plan) is just a click away.
Annual Notice of Changes
Click below to download the full list of benefit changes for 2024.
- 2024 Annual Notice of Changes – English
- 2024 Annual Notice of Changes – Portuguese
- 2024 Annual Notice of Changes – Spanish
- 2024 Annual Notice of Changes – Khmer
Provider/Pharmacy Directory
Click below to find a provider, specialist, hospital or pharmacy near you.
- 2024 Provider & Pharmacy Directory – English
- Updated 10/18/2023
- 2024 Provider & Pharmacy Directory – Portuguese (Coming Soon)
- 2024Provider & Pharmacy Directory – Spanish (Coming Soon)
- 2024 Provider & Pharmacy Directory – Khmer (Coming Soon)
To see a list of our pharmacies, you can search our Pharmacy Locator
To request a hard copy of the Provider Pharmacy Directory, call Neighborhood Member Services at 1-844-812-6896 (TTY 711).
Member Handbook (Evidence of Coverage)
Click below to get detailed information about your coverage with Neighborhood INTEGRITY.
- Member Handbook – English
- Member Handbook – Portuguese
- Member Handbook – Spanish
- Member Handbook – Khmer
List of Covered Drugs (Formulary)
Click below to download the full list of covered drugs under this plan.
- 2024 Formulary – English
- Updated 10/13/2023
- 2024 Formulary – Portuguese
- Updated 10/13/2023
- 2024 Formulary – Spanish
- Updated 10/13/2023
- 2024 Formulary – Khmer
- Updated 10/13/2023
Click below for a list of Durable Medical Equipment supplies limited at pharmacies.
- Durable Medical Equipment List – English
- Durable Medical Equipment List – Portuguese
- Durable Medical Equipment List – Spanish
- Durable Medical Equipment List – Khmer
Summary of Benefits
Click below for a summary of benefits available under the Neighborhood INTEGRITY plan.
- Summary of Benefits – English
- Summary of Benefits – Portuguese
- Summary of Benefits – Spanish
- Summary of Benefits – Khmer
Interpreter and Language Services
Click below for interpreter and language services available to you.
Sample ID Card
Click below to see a sample Neighborhood INTEGRITY member ID card.
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 English
Request for Drug Determination Form – Portuguese
Request for Drug Determination Form – Spanish
Request for Drug Determination Form – Khmer
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 English
Request for Redetermination of Part D Denial Form – Portuguese
Request for Redetermination of Part D Denial Form – Spanish
Request for Redetermination of Part D Denial Form – Khmer
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 English
Member Reimbursement Form for Part D Drugs – Spanish
Member Reimbursement Form for Part D Drugs – Portuguese
Member Reimbursement Form for Part D Drugs – Khmer
Use this form to request reimbursement if you paid the full cost of a prescription from one of our network pharmacies.
Member Consent for Release of Protected Health Information Form English
Member Consent for Release of Protected Health Information Form – Spanish
Member Consent for Release of Protected Health Information Form – Portuguese
Member Consent for Release of Protected Health Information Form – Khmer
Use this form to let another person see, receive or talk about your Protected Health Information.
Request for Alternate Means of Confidential Communications Form
Use this form to receive mail or phone calls at a different phone number.
Request for Access to Designated Protected Health Information Records Form
Use this form to get a copy of your Neighborhood records, such as pharmacy or claims information.
Annual Notice of Changes
Click below to download the full list of benefit changes for 2023.
- 2023 Annual Notice of Changes – English
- 2023 Annual Notice of Changes – Portuguese
- 2023 Annual Notice of Changes – Spanish
- 2023 Annual Notice of Changes – Khmer
Provider/Pharmacy Directory
Click below to find a provider, specialist, hospital or pharmacy near you. All directories were last updated on October 18, 2023.
- 2023 Provider/Pharmacy Directory – English
- 2023 Provider/Pharmacy Directory – Portuguese
- 2023 Provider/Pharmacy Directory – Spanish
- 2023 Provider/Pharmacy Directory – Khmer
To see a list of our pharmacies, you can search our Pharmacy Locator
To request a hard copy of the Provider Pharmacy Directory, call Neighborhood Member Services at 1-844-812-6896 (TTY 711).
Member Handbook (Evidence of Coverage)
Click below to get detailed information about your coverage with Neighborhood INTEGRITY.
- Member Handbook – English
- Member Handbook – Portuguese
- Member Handbook – Spanish
- Member Handbook – Khmer
List of Covered Drugs (Formulary)
Click below to download the full list of covered drugs under this plan.
- 2023 Formulary – English
- Updated 10/30/2023
- 2023 Formulary – Khmer
- Updated 10/30/2023
- 2023 Formulary – Portuguese
- Updated 10/30/2023
- 2023 Formulary – Spanish
- Updated 10/30/2023
Click below for a list of Durable Medical Equipment Supplies limited at pharmacies.
- Durable Medical Equipment List – English
- Durable Medical Equipment List – Portuguese
- Durable Medical Equipment List – Spanish
- Durable Medical Equipment List – Khmer
Summary of Benefits
Click below for a summary of benefits available under the Neighborhood INTEGRITY plan.
- Summary of Benefits – English
- Summary of Benefits – Portuguese
- Summary of Benefits – Spanish
- Summary of Benefits – Khmer
Interpreter and Language Services
Click below for interpreter and language services available to you.
Sample ID Card
Click below to see a sample Neighborhood INTEGRITY member ID card.
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
Request for Drug Determination Form – Portuguese
Request for Drug Determination Form – Spanish
Request for Drug Determination Form – Khmer
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.
Use this form to file an appeal of an adverse decision.
Request for Redetermination of Part D Denial Form
Request for Redetermination of Part D Denial Form – Portuguese
Request for Redetermination of Part D Denial Form – Spanish
Request for Redetermination of Part D Denial Form – Khmer
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
Member Reimbursement Form for Part D Drugs – Spanish
Member Reimbursement Form for Part D Drugs – Portuguese
Member Reimbursement Form for Part D Drugs – Khmer
Use this form to request reimbursement if you paid the full cost of a prescription from one of our Network pharmacies.
Member Consent for Release of Protected Health Information Form
Member Consent for Release of Protected Health Information Form – Spanish
Member Consent for Release of Protected Health Information Form – Portuguese
Member Consent for Release of Protected Health Information Form – Khmer
Use this form to let another person see, receive or talk about your Protected Health Information.
Request for Alternate Means of Confidential Communications Form
Use this form to receive mail or phone calls at a different phone number.
Request for Access to Designated Protected Health Information Records Form
Use this form to get a copy of your Neighborhood records, such as pharmacy or claims information.
Out-of-network/non-contracted providers are under no obligation to treat Neighborhood INTEGRITY members, except in emergency situations. Please call Member Services or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.
Questions?
Please call us at 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday; 8 a.m. to 12 p.m. 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.
Our plan can also give you materials in Spanish, Portuguese, and Khmer 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 31, 2023 @ 8:56 am
H9576_WebMaterials24 Approved, 10/24/2023