product places the Primary Care Physician (PCP) at the center of patient care and promotes timely, preventative services and quality medical care, in the appropriate setting.
The HMO offers members:
HealthPlus HMO ID card
highlights important information providers will want to review at the point of contact with the member:
- Front of the card includes:
office visit, Urgent Care and ER copay information.
- Back of the card includes:
referral and prior authorization direction, claim submission address, telephone numbers and the networks subscribers are covered through, when traveling outside of the HealthPlus service area.
Member benefit summaries, are available for review by providers, while confirming eligibility through the secured, on-line provider service center. Viewing the benefit summaries will assist the provider in better understanding the benefits available to the member, as well as the level of reimbursement that should be collected by the provider, at the time services are rendered.
Primary Care Physician (PCP)
HMO members must select a PCP from the HealthPlus HMO provider network. The
HealthPlus Provider directory, offers a comprehensive listing of PCPs who are currently accepting new members. The PCP is responsible for coordinating all of the member's medical care, including hospitalization. If a member is in need of specialty care, the PCP is responsible for preparing a referral to an in-plan specialist. When a member selects a PCP, they are also required to use the hospital system with which the PCP is affiliated.
In the event that a member requires specialty care, the PCP will initiate a referral to a HealthPlus HMO specialist or appropriate medical professional. Referrals are not necessary for some services, such as routine gynecological and obstetrical care. Referrals must be submitted via the web, unless there is an urgent health care need.
For more questions related to the HealthPlus HMO, please contact the Customer Service Department at: 888-212-1512.