Enrollment and service area

You’ll use plan providers to get covered services. Now that you’re a member of HAP Empowered MI Health Link, with few exceptions, you must use plan providers to get covered services.

What are plan providers?

This is the term for doctors, other health care professionals, hospitals and other health care facilities licensed or certified by Medicare and the state to provide health care services. We call them plan providers when they participate in HAP Empowered MI Health Link. When we say they participate in HAP Empowered MI Health Link, we’ve arranged with them to coordinate or provide covered services.

What’s a medical emergency?

A medical emergency is when you reasonably believe your health is in serious danger. This is severe pain, bad injury, serious illness or medical condition quickly getting worse.

If you have a medical emergency

Get help as soon as possible. Call 911 or go to the nearest emergency room. You don’t need to get permission first from your primary care physician or other plan providers. Make sure your PCP knows about your emergency. He or she needs to be involved in following up on your emergency care. You should tell them about your emergency care within 48 hours. Your PCP's telephone number is on your HAP Empowered MI Health Link member card.

What's covered if you have a medical emergency?

You get covered emergency medical care anywhere in the United States. See the Evidence of Coverage for how we cover outpatient prescription drugs in an emergency situation while you’re outside the service area. Ambulance services are covered in situations where other transportation would risk your health.

What if it wasn't a medical emergency?

It can be hard to know if you have a real medical emergency. You might go in for emergency care thinking your health is in serious danger and the doctor says it isn’t an emergency. If this happens, you’re still covered for care you got to determine what was wrong.

If you get care after the doctor says it wasn’t a medical emergency, we’ll pay our portion of the covered additional care if you get it from a plan provider. If you get care from a nonplan provider after the doctor says it wasn’t a medical emergency, we’ll usually not cover the additional care. We’ll pay our portion of the covered additional care from a nonplan provider if you’re out of our service area and it meets the definition of urgently needed care given below.

Urgently needed care is when you need medical attention right away for an unplanned illness or injury. It’s not practical for you to get care from your primary care physician or other plan providers. Your health isn’t in serious danger. As we explain below, how you get urgently needed care is based on if you’re in or outside the plan's service area.

What’s the difference between a medical emergency and urgently needed care?

The main difference is in the danger to your health. Urgently needed care is if you need medical help soon, but your health isn’t in serious danger. A medical emergency is if you think your health is in serious danger.

Getting urgently needed care when you’re in the plan's service area

If you have a sudden illness or injury not a medical emergency, and you’re in the plan's service area, call your PCP at the number on your member card. You’ll learn how to get care. There will always be a health professional on call. If you have an urgent need for care while in the plan's service area, we expect you to get care from plan providers. In most cases, we’ll not pay for urgently needed care from a nonplan provider while you’re in the plan's service area.

Getting urgently needed care when you’re outside the plan's service area

We’ll cover urgently needed care from nonplan providers when you’re outside the plan's service area, but still in the United States. If you need urgent care outside the plan's service area, please first call your PCP. If you’re treated for an urgent care condition out of the service area, please return to the service area to get follow-up care through your PCP. We’ll cover follow-up care from nonplan providers outside the plan's service area if the care still meets the definition of urgently needed care.

We cover renal (kidney) dialysis services when temporarily outside the plan's service area. See the Evidence of Coverage for more information on filling your prescription drugs when you’re getting urgently needed care and when you’re outside the plan’s service area.