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Using your plan

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

What is an HMO?

HMO stands for health maintenance organization. All of your care is coordinated through a primary care physician (PCP) whom you can select. Your PCP will provide your covered preventive care, keep your medical history and help you choose a specialist when you need one. While you can refer yourself to some in-network specialists, such as an allergist or a dermatologist, you will need a referral from your PCP in order to get specialty care. You are covered worldwide for emergency and urgent care.

Where can I seek care with an HMO?

In addition to worldwide Emergency Room and Urgent Care coverage, you can seek care in any of the following counties:

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

Find an HMO doctor

Students Away at School Program

With prior authorization, students with HMO plans have expanded coverage. This coverage includes services that aren’t normally covered out of their HMO network, such as:

  • Required maintenance visits for chronic conditions
  • Allergy injections
  • Prescription coverage (as allowed under the member’s medication rider)
  • Acute illness or injury:
    • Follow-up office visit
    • Outpatient imaging and laboratory tests
    • Physical therapy for rehabilitation
    • Durable medical equipment (with DME and Prosthetics & Orthotics rider)
  • Routine immunizations

The following services aren’t covered under the Students Away at School Program for HMO members:

  • Routine physical exams
  • Routine gynecology exams
  • Outpatient, nonemergency mental health and substance abuse care
  • Elective surgery or hospital stays
  • OB-GYN services for pregnancy
  • Doctor visits and physical therapy, outpatient therapy or other therapies, or treatments that don’t have prior authorization

Note: Students must be between 5 and 26 years of age and in school full time. The Students Away at School Program doesn’t cover dependent children who live with a custodial parent outside of our service area.

Choosing your primary care physician (PCP)

All HAP HMO plan members pick a primary care physician (PCP). The PCP coordinates your care and keeps your medical history up to date. Thankfully, HAP’s networks give you access to thousands of doctors and the leading hospitals.

  • Choose who you like — when you like. Unlike other HMOs, you can change your PCP whenever you like. Everyone on your HAP HMO plan is free to choose the PCP of their choice. Your PCP keeps your health care history and can speak to specialists on your behalf. This way, you’re not alone. You always have a health care team collaborating about your care.
  • Freedom to see your HAP dermatologist or your kids’ allergist without referrals. In fact, you won’t need referrals to visit many of our specialists.
  • Paperless and hassle-free referrals. If you need a referral to a specialist or ancillary provider, such as X-rays or lab tests, it’s paperless with HAP. Your PCP does all the work for you. You simply show up at your appointment and your paperwork has already arrived.

Emergency and urgent care overview

Dealing with an urgent or emergency situation isn’t something you want to go through. But knowing where to go for care before something happens is important. With HAP, you can quickly take care of any health issue that may come up. Across the nation or the around globe - your HAP medical coverage will be there for you.

Knowing the difference between urgent and emergency conditions

It’s important to know the difference between the two situations 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.

Why urgent care is often a better option than the emergency room

In most cases it will cost you less out-of-pocket to visit an affiliated urgent care center than an emergency room.

So unless there’s a medical emergency (broken bone, chest pains, difficulty breathing, severe burn, etc.), it usually makes more sense to go to urgent care – and save yourself the extra money.

Urgent care centers are staffed by fully accredited doctors and are as equally equipped as ERs to handle issues like sprains, cuts that require stitches, minor burns, back pain, the flu and more. Wait times at urgent care centers also tend to be shorter than ERs.

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 the maintenance drug list at hap.org/prescriptions, 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.

Quick, easy access to your health information once you’re a HAP member

You can access all your important information in one convenient place through at the member portal at hap.org. Here you can log on and review or print:

  • Plan documents such as:
    • Subscriber contracts
    • Benefit summary
    • Riders
  • Claims information
    • Explanation of Benefit statements

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*Only 2017 plans are available for Jackson County.

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