HMO plan basics

With a HAP HMO plan, you'll get world-class care through a network of leading doctors and hospitals.

What is an HMO?

An HMO is a type of health plan where you receive care within a specific network of doctors and hospitals. HMO plans require you to pick a primary care physician, also known as a PCP, who is part of that network. Think of your PCP as your point person. He or she provides all your basic health care services. You also can see a specialist at any time as long as they are in your network. Your PCP will help you choose one.

You have the freedom to see your HAP dermatologist or allergist without referrals. In fact, in our provider network, many specialty office visits don’t require referrals from your PCP. These specialties include: allergy, cardiology, dermatology, podiatry, OB-GYN, routine labs and standard X-ray. If you do need a preauthorization (often called a referral) before you get a service, our paperless referral system makes the process hassle-free. Your PCP does all the work for you. You simply show up at your appointment and your referral will have already arrived.

Coverage that travels with you

With worldwide coverage for emergencies and urgent care, plus an emergency travel assistance program through Assist America, you won't have to worry when you leave home. No matter where you go, urgent care and emergency services are covered if you get sick or hurt.

HAP service area

In addition to worldwide emergency and urgent care coverage, you can seek care in any of the following counties which form the HAP service area:

19 county hmo map

  • Arenac
  • Bay
  • Genesee
  • Huron
  • Hillsdale*
  • Iosco
  • Jackson
  • Lapeer
  • Livingston
  • Macomb
  • Monroe
  • Oakland
  • Saginaw
  • Sanilac
  • Shiawassee
  • St. Clair
  • Tuscola
  • Washtenaw
  • Wayne

*Effective 1/1/18, pending state approval.

Students away at school

Members who have children that are away from home at school can rest assured they will be covered under HAP. Children ages 5 to 26, who go to school outside HAP’s coverage area, are covered for emergencies and urgent care. While students are away at school, common medical services are treated as in-network service, with prior approval:

  • Allergy injections
  • Prescription coverage as allowed under the members prescription medication rider
  • Required maintenance visits for chronic conditions as authorized by HAP
  • Routine immunizations or vaccines according to the recommendations from the Centers for Disease Control and Prevention, or CDC
  • Treatment related to an acute illness or injury

Telehealth services

Getting health care online has never been easier because HAP partners with American Well to bring you telehealth services. Doctors are now available 24/7 for live, online visits.  

You can see your doctor using your mobile phone, tablet or computer. Our telehealth services have many convenient benefits:

  • Using Telehealth services for nonemergency illnesses can save you money compared to visiting an urgent care or ER
  • Telehealth services are available when you are traveling for work or on vacation
  • Your spouse can create a separate account to access telehealth services and so can your child if they are over 18

It's free to enroll. HAP members can follow these easy steps:

Desktop users:

  1. Visit hap.amwell.com.
  2. Enter your information and click Sign Up.
  3. When prompted, you must use the following service key: HAPMi.

Mobile users:

  1. Search Apple's iTunes or Google's Play app store for Amwell and download the app.
  2. Enter your information and click Sign Up.
  3. When prompted, you must use the following service key: HAPMi.

Urgent Care or ER?

It's important to know the difference between urgent and emergency conditions to make sure you get the right care at the right time. This can save you out-of-pocket expenses and ensure you're treated quickly based on your condition. In most cases it will cost you less out-of-pocket to visit an affiliated urgent care center than an emergency room. Here's a convenient info graphic showing where you should go if you are ill or hurt.

Convenient prescription coverage

To make sure you get quality medications, HAP uses a drug formulary. A formulary is a list of covered drugs and their respective copay tier, selected by HAP in consultation with a team of health care providers.

Here are a few highlights of drug coverage:

  • Prescriptions available at most major national pharmacy chains and many independent pharmacies.
  • If your medication is included on our maintenance drug list (PDF), we'll provide up to a 90-day supply.
  • You can also use our convenient mail order pharmacy, Pharmacy Advantage to easily and securely refill or renew your prescriptions at pharmacyadvantagerx.com.
  • Medications that aren't on our maintenance drug list are generally limited to a 30-day supply or may be approved for a 90-day supply

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  • Annual Enrollment Period Meeting

    Get answers to your Medicare questions! Learn how Medicare works and learn about HAP’s wide range of Medicare solutions.

  • Annual Enrollment Period Meeting

    Get answers to your Medicare questions! Learn how Medicare works and learn about HAP’s wide range of Medicare solutions.

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Contact us

  • Customer service

    (800) 422-4641

     

    Email

     

    More options

  • Individual and family plans

    Ready to join?

    (855) 948-4427

    HMO Plans

    (800) 759-3436

    PPO Plans

    (800) 944-9399

  • Insurance through your employer

    Alliance Health and Life Insurance Company®

    (888) 999-4347

    Self-funded / ASO

    (866) 766-4709

    HAP HMO

    (800) 422-4641

    HAP Midwest Health Plan

    (888) 654-2200

  • Medicare

    Ready to join?

    (800) 868-3153 TTY: 711

    HAP Senior Plus®

    (800) 801-1770 TTY: 711

    HAP Senior Plus® (PPO)

    (888) 658-2536 TTY: 711

    Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711