Explore HAP’s 2019 plan information brochure

HMO plan basics

With a HAP HMO plan, you'll get world-class care through a network of leading doctors and hospitals.

What is an HMO?

An HMO is a type of health plan where you receive care within a specific network of doctors and hospitals. HMO plans require you to pick a primary care physician, also known as a PCP, who is part of that network. Think of your PCP as your point person. He or she provides all your basic health care services. You also can see a specialist at any time if they are in your network. Your PCP will help you choose one.

  • HMO plans require you to pick a primary care physician, also known as a PCP, who is part of that network. Think of your PCP as your point person. He or she provides all your basic health care services. 
  • With HAP, you can choose who you like, when you like. Unlike some other HMOs, you can change your PCP when you want to. Everyone on your plan can select the PCP of their choice. Your PCP keeps your health care history updated and can speak to specialists on your behalf. This way, you’re not alone. You always have a health care team working together for your care.

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?

Referrals

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.

Example:

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 doesn’t have any involvement in the doctor’s request.

Prior authorization

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.

Example:

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.

HAP network and service area

HAP HMO network

With a long history and deep roots in Michigan, HAP has built provider networks that offer our members some of the best health care available across the state. We continue to build outstanding networks that include leading doctors and hospitals. Members with the HAP HMO plan can seek care through our HMO network in Michigan. The HMO network gives you access to thousands of doctors and leading hospitals.

Find an HMO doctor


HAP UAW Trust service area

UAW Trust members must live in one of the following counties to choose HAP: 

  • Arenac
  • Bay
  • Genesee
  • Huron
  • Iosco
  • Lapeer
  • Livingston
  • Macomb
  • Monroe
  • Oakland
  • Saginaw
  • Sanilac
  • Shiawassee
  • St. Clair
  • Tuscola
  • Washtenaw
  • Wayne

Worldwide emergency, urgent care and travel assistance 

Outside of our service area, HAP members are covered worldwide for emergency and urgent care. HAP’s partnership with Assist America provides members with additional emergency travel assistance, including services for lost luggage, travel documents, hospitalization, emergency evacuation and more.

Students Away at School Program

You can have peace of mind knowing your college students can get care when they need it.

Students ages 17 through 25 who are covered by a parent’s plan while away at school will be covered outside of HAP’s service area for emergency or urgent care, plus a wide range of non-emergency services (with prior authorization), including:.

  • Routine allergy injections, flu shots and immunizations
  • Required maintenance visits for chronic conditions, such as asthma or acne
  • Office visits for a birth control prescription or to continue birth control
  • Prescription drugs (according to your health plan)
  • Telehealth services through Amwell®

Students ages 17 through 25 who are covered by a parent’s plan while away at school will be covered outside of HAP’s service area for emergency or urgent care, plus a wide range of non-emergency services (with prior authorization), including:

  • Routine allergy injections, flu shots and immunizations
  • Required maintenance visits for chronic conditions, such as asthma or acne
  • Office visits for a birth control prescription or to continue birth control
  • Prescription drugs (according to your health plan)
  • Telehealth services through Amwell®

Students Away at School doesn’t cover dependent children who live with a custodial parent outside our service area. Costs for care and prescription drugs outside HAP’s service area may be higher, so getting care at home is still best.

Urgent care or ER?

It’s important to know the difference between urgent and emergency conditions 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.

In most cases it will cost you less out-of-pocket to visit an affiliated urgent care center than an emergency room.

Here’s a convenient infographic showing where you should go if you are ill or hurt.

Understanding deductibles

A deductible is a fixed amount of money you have to pay annually before HAP begins paying its portion of your medical costs. Generally, prescription drugs and medical services covered by a flat copay do not count toward the deductible. All other covered services without copays count toward the deductible.

A health insurance deductible works similar to auto insurance. Let’s say you are involved in an accident. First, you have to pay your deductible amount, and then your insurance company pays for the rest for the repair work. Health insurance deductibles work the same way.

Enroll in HAP today. Call Retiree Health Care Connect at (866) 637-7555.

 

Health plan terminology

This short video explains benefits, deductibles, copays, coinsurance, and out-of-pocket maximums so you can make the right decisions. (Video, 3:15)

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Understanding out-of-pocket costs

Even when a service or medication is covered, you may pay part of the cost. Learn how out-of-pocket costs like copays, coinsurance and deductibles work. (Video, 2:41)

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    (855) 948-4427

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    (800) 759-3436

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    (800) 944-9399

  • Insurance through your employer

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    (888) 999-4347

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    (888) 654-2200

  • Medicare

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    (800) 868-3153 TTY: 711

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    (800) 801-1770 TTY: 711

    HAP Senior Plus® (PPO)

    (888) 658-2536 TTY: 711

    Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711