To maintain the best possible care for our members, HealthPlus has adopted a formal set of standards and procedures to ensure that our members have continuous access to health care services.
Accessibility of Care
HealthPlus requires access to primary care and specialist practitioners for required medical care 24 hours a day, seven days a week, under applicable state and federal HMO laws. HealthPlus members are encouraged to contact their primary care physicians for coordination of all medical care.
In accordance with generally accepted medical standards:
- Urgent care will be provided the same day.
- Routine symptomatic, non-urgent care will be provided within 4 calendar days.
- Non-symptomatic and preventive care will be provided within 30 calendar days.
For behavioral health care, HealthPlus medical standards are:
- Non-life-threatening emergency services provided within 6 hours
- Urgent care provided within 48 hours
- Routine, non-urgent care provided within 10 working days
When the office is closed, the primary care physician (or designee) must be available to members, by telephone, 24 hours a day and 365 days per year. Availability may be through an answering service or a recorded telephone message, providing the telephone number of a covering physician or directions for emergency care.
Practitioners are monitored to ensure that service levels are met. Compliance with these access standards is monitored by HealthPlus and a corrective action plan is developed when needed to address opportunities for improvement.