The HealthPlus HMO plan is for individuals and families who want a comprehensive package of health care benefits with affordable, predictable out-of-pocket costs and virtually no paperwork.
- Choose a Primary Care Physician (PCP) who provides and coordinates all of your care
- Coverage for preventive, routine medical and specialty care
- Coverage for emergencies worldwide
- Access to wellness programs
- Disease management programs for diabetes, asthma and heart disease
- HealthQuest Rewards Program with discounts on fitness clubs, weight loss programs and more
One of America’s Best Solutions for Health Care Coverage!
HealthPlus of Michigan is ranked among the Top 50 Commercial health plans in the U.S.News & World Report/NCQA “America’s Best Health Plans” 2007* list.
* “America’s Best Health Plans” 2007 is a trademark of U.S.News & World Report.
How the HMO Plan Works
Primary Care Physician
When you enroll, you’ll select a PCP from our HealthPlus HMO provider network. Your PCP provides and coordinates all of your medical care. If you need care from a specialist, your PCP will provide a referral.
When you select your PCP, from the HMO provider network, a primary hospital goes with the designation and you will use that facility for all or most of your inpatient and outpatient services.
Locating a HealthPlus PCP is easy:
- Call our toll-free number, 1-800-332-9161, and speak to one of our friendly customer service representatives.
Comprehensive Benefits
Your HMO benefits include:
- Doctor’s office visits and specialist care
- Well child care
- Routine physicals
- Preventive screenings
- OB/GYN care
- Immunizations
- Lab tests
To receive coverage, you simply present your ID card and pay any applicable copayment at the time of service.
Referrals
If you need specialty care, your PCP will refer you to another physician or appropriate medical professional. Referrals are not necessary for some services, such as routine gynecological and obstetric care. Although HealthPlus contracts with thousands of providers, your PCP will generally send you to a specialist affiliated with his or her own hospital.
Emergency Coverage 24/7
HealthPlus covers emergency care 24 hours a day, seven days a week, anywhere in the world. If you have a life-threatening emergency call 911 or go to the nearest emergency facility. If you are hospitalized, you or your representative should contact your PCP and HealthPlus within 24 hours or as soon as possible.
Online Wellness Center
Our informative Web site provides an invaluable source of interactive information on how to eat right, stay fit and stay healthy. You may record and manage your own "Personal Health Record" so your health history is easy to access when you need it. Our interactive health risk assessment tools give you insight into the likelihood of developing common health conditions. Plus, we have tools to help you set-up health-smart goals like smoking cessation, weight loss, etc. and keep track your progress.
Coverage for College Students
If you have dependent college students who are in the plan, you must choose a PCP within the HealthPlus service area for their routine medical services, such as annual physicals. However, if they attend a college outside of our service area, they are automatically covered for urgent and emergency services
HealthQuest Perks Program**
HealthPlus wants to help you attain your total health goals and feel better about yourself. So our HealthQuest Perks Program provides valuable discounts on fitness and weight loss programs, as well as on medical supplies like blood pressure cuffs, pedometers, weight scales and more.
Have questions?
Get answers on our HealthPlus Web site at Contact Form or call our award winning Customer Service Representatives at 1-800-332-9161.
**HealthQuest Rewards is a value-added program and the services and products made available under this program are not covered benefits under HealthPlus of Michigan subscribers' contracts or otherwise payable by HealthPlus. HealthPlus, its affiliates, subsidiaries, agents and assigns, make no representations or warranties regarding the quality, price, or effectiveness of the services or products, or the credentialing of the providers, made available by HealthQuest Rewards.
Glossary of Terms
Primary Care Physician (PCP) – An affiliated provider (Family Practitioner, Internal Medicine or Pediatrician) in our network, who coordinates the total health care of the member including routine medical care, preventive care, and provides referrals for specialists, procedures and hospitalizations.
Copayments – A fixed or percent dollar amount that a member pays for covered services. The copayment is due at the time of service or when billed by the provider.
Referral – An authorization initiated by your PCP to coordinate care with a specialist or other provider.
Refer to the Benefit Rider(s) for details on copayments, deductibles and coinsurance and services to which they apply.
