This short video explains benefits, deductibles, copays, coinsurance, and out-of-pocket maximums so you can make the right decisions. (Video, 3:15)Open video transcript
HMO plan basics
With a HAP HMO plan, you'll get world-class care through a network of leading doctors and hospitals.
Not your ordinary HMO plan
When enrolled in HAP's HMO plan, you can choose your doctor from thousands of highly qualified primary care physicians (PCPs). Chances are, your current doctor and hospital are already part of an established network of providers. Search our tool to check.
As a HAP member you’ll choose a PCP. Your PCP may recommend specialty services from a certain specialist or facility, but you can choose to receive the care you need from any HAP contracted specialist without a referral.
With HAP, you can change your PCP when you want to. Everyone on your plan can select the PCP of their choice.
Referrals and authorizations
With a HAP HMO plan, there may be times where your doctor requires a referral. Or you may need to have a procedure that needs to be approved by HAP before you have it done. But what’s the difference between a referral and prior authorization?
HAP doesn’t require you to get a referral to see a specialist in your network for an initial consultation. However, the specialist you visit may require a referral from your primary care physician. The schedules for certain specialists get filled months in advance. They may only accept patients whose primary care physician believes the patient needs specialty care.
Mary suffers from chronic sinus infections several times a year, so she wants to see an ear, nose and throat doctor. She schedules an appointment with the specialist within her network.
- HAP doesn’t require a referral for Mary to see this doctor.
- The doctor’s office may require a referral from Mary’s PCP. This isn’t a HAP requirement.
HAP works with primary care physicians and specialists to ensure patients receive the right treatment, at the right time and in the right setting. That’s why we want you to check with us so we can help manage your care.
This is called prior authorization. If services require prior authorization, your doctor will handle it on your behalf.
After Mary has an appointment with the ear, nose and throat specialist, a surgical procedure was recommended. Before she has the surgery, the ENT’s office must contact HAP and provide clinical information to get prior authorization to make sure the service is covered and that it’s medically necessary.
For hospital stays
For inpatient hospital stays, your doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization.