HealthPlus POS
The HealthPlus POS plan is ideal for those who prefer the costs savings of an HMO and the freedom and flexibility to go directly to a specialist without a referral for most covered services:
- Members are encouraged to select a primary care physician (PCP)
- Coverage for preventive, routine medical and specialty care
- Coverage for emergencies worldwide
- Care provided or arranged through the PCP results in lower out-of-pocket costs and minimal paperwork
- Members may self-refer to a specialist or other health care provider for higher out-of-pocket cost
- 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
How the POS Plan Works
Primary Care Physician
When you enroll you are encouraged to select a physician from more than 700 participating primary care physicians (PCP). Your PCP can provide or arrange for all the care you need including, treatment when you are ill, routine physicals, preventive screenings, immunizations and more. Your PCP will provide a referral if you need care from a specialist.
Locating a HealthPlus PCP is easy:
- Use our online Provider Directory
- Check out our printed Provider Directory
- Call our toll-free number, 1-800-332-9161, and speak to one of our friendly customer service representatives
Flexible Benefits
POS members have flexibility and choice when accessing care. The highest level of coverage is for services performed by or arranged through the PCP. These are considered Level 1 benefits. For a higher level of cost sharing a member may self-refer to any Affiliated Provider (Level 2 benefits) or Non-Affiliated Provider (Level 3 benefits).
PCP Directed Option – Level 1 Benefits
When you receive care that is provided by your PCP your care is covered under the maximum level of benefits, Level 1 benefits. You show your ID card and pay the applicable copayment at the time you receive services. There are normally no bills or paperwork involved.
If you need to see a specialist your PCP will generally refer you to a participating specialist. Services authorized by your PCP are also paid under Level 1 benefits.
Self-Referral Option – Levels 2 and 3 Benefits
You can also choose to seek care without a referral from your PCP. You will be responsible for a higher level of cost-sharing when you self-refer. If you self-refer to a participating provider your covered services are paid at Level 2 benefits. You may be responsible to pay a deductible in addition to a percent of the cost of service.
You also have the option to self-refer to a non-participating provider. Covered services to non-participating providers are paid at Level 3 benefits. In addition to your deductible and copayment you may be responsible for paying any difference between what the plan covers and what the provider has charged for the service.
If you need to be hospitalized for an elective surgery you must call and receive prior approval from HealthPlus. If you don’t receive prior approval, you coverage will be reduced.
Travel Coverage
When traveling outside the HealthPlus service area, HealthPlus POS covers you when you need unexpected medical care (broken bones, flu, earaches, poisoning, etc.). Just call the travel network telephone number on the back of your HealthPlus Identification card for the nearest medical facility.
Emergency Coverage 24/7
HealthPlus covers emergency care 24 hours a day, even 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.
Emergency care is always covered at Level 1 benefits.
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.
HealthQuest Rewards Program*
HealthPlus wants to help you attain your total health goals and feel better about yourself. So our HealthQuest Rewards 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.
Enjoy discounts on services and products from GlobalFit, Jenny Craig, Weight Watchers, Diet Workshop and EdgePark Surgical Supply.
Have questions?
Get answers on our HealthPlus Web site 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 subscriber 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
POS Plan - A health plan that allows members to choose between PCP directed care or a self-referral option each time they seek health care services. Members receive the highest level of coverage, Level 1 benefits, for services provided by or arranged through their PCP.
Affiliated Provider – Doctors, hospitals and other medical professionals that belong to our POS provider network.
Non-Affiliated Provider – Doctors, hospitals and other medical professionals that are not in our POS provider network.
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.
Deductible – A dollar amount you must pay each benefit year before services are covered under your health plan.
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.
HealthPlus POS
Customer Service
1-800-332-9161
FLINT: 2050 S. Linden Road ● Flint, MI 48532
SAGINAW: 5454 Hampton Place ● Saginaw, MI 48604
