Using your plan

Whether your employer offers an HMO, PPO or EPO, 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

What are the HAP Choice networks?

If you have an HMO, your employer may offer one of two HAP Choice networks. The Henry Ford Choice network allows you to select from a wide range of doctors and hospitals within the Henry Ford Health System. It includes nearly 5,000 doctors within Macomb, Oakland and Wayne counties.

The Genesys Choice network allows you to select from a wide range of doctors and hospitals within the Genesys Physician Hospital Organization. It includes nearly 4,000 doctors within Genesee county.

If you select a HAP Choice network it’s easier for your primary care physician to coordinate your care with other network doctors.

Find an HMO Choice Henry Ford doctor

Find an HMO Choice Genesys doctor

What is a PPO?

PPO stands for preferred provider organization. You don’t need to select a PCP with a PPO plan. However, you can use a PCP to help you navigate your health services. This way, you receive the most complete care possible. When you belong to a PPO plan, you are covered for preventive services and specialty care received from an affiliated provider. If you decide to use a specialty provider who is not affiliated, you may pay higher out-of-pocket costs.

As a PPO member, you can use the statewide network of doctors and hospitals. Additionally, PPO members can access care nationwide through CIGNA's network of doctors.

Find a PPO doctor

What is an EPO?

The exclusive provider organization, also known as an EPO, offers the freedom of our PPO but without the out-of-network benefits. You will not have to choose a PCP as a member of this plan. You may see any doctor or specialist within the EPO network, without a referral. EPO members can also access our statewide network throughout the state of Michigan.

Find an EPO doctor

Students Away at School Program for HMO and EPO members

Students with PPO coverage have access to covered services across the country. With prior authorization, students with HMO or EPO plans have expanded coverage. This coverage includes services that aren’t normally covered out of their HMO or EPO 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 or EPO 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.

Learn more about prescription coverage.

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