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EPO: FAQs

Is a PCP assignment required for members in the EPO plans?
No, there is no PCP assignment required for Alliance and HAP Preferred EPO members.

Are referrals required for EPO members seeking specialty care?
No, PCP directed care for specialty services is not required for Alliance and HAP Preferred EPO plans.

Are there out-of-plan benefits for EPO members?
No, all care must be provided by an Alliance or HAP Preferred contracted EPO provider except for urgent and emergency care when traveling outside of the Alliance or HAP Preferred market area.

Is prescription coverage available?
Prescription coverage is an available option for Alliance and HAP Preferred EPO plans.

Are member copays included as a cost sharing option for EPO plans?
Copays are optional on Alliance and HAP Preferred EPO plans.

Is member coinsurance a cost sharing option for EPO plans?
Coinsurance is optional on Alliance and HAP Preferred EPO plans.

Are deductibles a cost sharing option for EPO plans?
Deductibles are optional on Alliance and HAP Preferred EPO plans.

What is the funding arrangement for the EPO plans?
Alliance and HAP Preferred EPO plans are experience-rated or self-funded.

Are the EPO plans Heath Savings Account compatible?
HSAs are an optional feature for Alliance and HAP Preferred EPO plans.

What happens when a member changes to HAP from another health care plan while they are in an active treatment plan?
To ensure that the transition to their new health plan is a smooth one, HAP offers continuity of care benefits to new members. Continuity of care allows members to continue to receive medical care from their current health care provider if he or she is currently involved in an active, covered treatment plan that if interrupted, could seriously affect their health.

New members should contact our Client Services department to begin the process. HAP will transfer the member to an affiliated provider when possible, without disturbing the care being provided through their current treatment plan.

Do the EPO plans offer worldwide coverage?
Yes, EPO members are covered worldwide for emergency and urgent care.

What is the EPO plan market area?
The EPO market area includes the counties of the HAP expanded market area:
Arenac
Bay
Clare
Genesee
Gladwin
Gratiot
Huron
Iosco
Isabella
Lapeer
Livingston
Macomb
Midland
Monroe
Oakland
Ogemaw
Roscommon
Saginaw
Sanilac
St. Clair
Tuscola
Washtenaw
Wayne

Who do I call for claims inquiries?
The HAP claims department is available at:
(313) 664-9047 or
(866) 766-4661

Who can I contact for customer service?
The HAP sales team is available at:
(800) 950-7455
hap_direct@hap.org
8 a.m. tp 5 p.m.
Monday through Friday

Client Services is available to answer Alliance member inquires at:
(313) 664-7010 or
(888) 999-4347
Monday through Friday 7 a.m. to 7 p.m. Saturday 8 a.m. to noon

HAP Preferred members should call their TPA.

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