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Emergency, Urgent and Routine Care Defined

If I’m a member of HAP Senior Plus, what happens when I travel?

As a member of HAP Senior Plus:

  • You are covered for emergencies wherever you travel – worldwide! (Remember: Original Medicare does not cover services outside the United States with the exception of a very limited area in Canada and Mexico).
  • You are covered for urgently needed care wherever you travel – worldwide
  • HAP Senior Plus also covers routine dialysis for members while they are temporarily outside our service area.
  • Finally, you can have prescriptions filled across the United States through one of our many national pharmacy network participants (such as Walgreens or Kmart).

This coverage is extremely important, so we want to be sure you have access to the care you need while away from our service area.

Neither HAP nor Medicare will cover routine care provided outside the network. Before explaining the rationale for this, definitions of each type of care may be useful:

  • Emergency: when you reasonably believe that your health is in serious danger and every second counts (such as severe pain, a bad injury, or a medical condition that is quickly getting much worse).
  • Urgent Medical Condition: Sprained ankles, most burns, minor wounds requiring stitches, back pain, chronic headaches, urinary tract infections, and severe cold or flu are typical examples of urgent conditions. An urgent condition may not be life threatening but may require prompt attention. This care is covered outside the HAP service area (worldwide); within the service area it must be obtained from HAP providers or at HAP-contracted urgent care facilities except in extraordinary situations such as the HAP network not being available.
  • Routine Care: Care that you can schedule ahead of time and that, if delayed, will not cause a health problem is considered routine care. Examples might be getting a flu shot or having a routine physical.

Because of the vital role your Personal Care Physician (PCP) plays in coordinating all the services you need, it is important to contact your PCP as soon as is possible after receiving urgent or emergent care so he/she can help with any follow-up care or can share important information with the physicians who are treating you.

Receiving routine care without the knowledge of your Personal Care Physician makes it difficult for your PCP to help ensure that the care you receive is effective and does not conflict with other treatment you are receiving or other conditions you may have. Since routine care can be delayed until you return to the HAP service area without causing harm to your health, such care is not covered under HAP Senior Plus – either by HAP or by Medicare.

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