HAP

FAQs

Health Care Reform for Groups

  • Is our Group plan Grandfathered?
    Group health plans and health insurance plans that were in place on March 23, 2010, when the PPACA was enacted, are called grandfathered plans and are exempt from some elements of the law. However, to maintain grandfathered status, a plan cannot reduce or eliminate benefits, increase employee cost-sharing above certain thresholds, or reduce the employer share of the premium payment. Once a plan loses its grandfathered status, it must comply with all applicable requirements of the law. It is the employer group’s responsibility to determine if the plan is grandfathered or not.
    TAGS: LargeGroup|SmallGroup|HCR

Purchasing Personal Alliance Individual and Family Products

  • How long does it take to enroll?
    The application will take minimal time to complete. The applicant should be certain to have key information needed to enroll everyone on their contract such as names, birthdates and SSN. It’s also suggested that applicants determine their plan selection prior to starting the application process.

    Coverage will take effect once the application is submitted and payment is received. Effective dates are the first of the month and follow the rules below: The effective date of coverage will be determined based on the date that we receive a fully completed application.
    • If the application is received on or before the 15th of the month, coverage will take effect the 1st of the month following
    • If the application is received on the 16th through the end of the month, coverage will take effect the 1st of the second following month.


    Example: If an applicant applies and is accepted for coverage by December 15th, coverage will take effect on January.
    If the applicant applies and is accepted for coverage by December 16th, coverage will take effect on February.
    TAGS: Individual|Family|Purchasing
  • Should I cancel my existing coverage?
    We do not suggest that you cancel existing coverage until you have been fully enrolled and your effective date of coverage in your new plan has been confirmed. To avoid paying duplicate premiums, it is best to “match up” the termination date of existing coverage with the start date of new coverage.
    TAGS: Individual|Family|Purchasing|Enroll
  • You may enroll online, complete a paper application or visit us at our retail sites where we have Personal Alliance experts to assist you. You may also call us at (855) 948-4427 and we can enroll you over the phone in our Personal Alliance products. Here’s where you can come and talk with us:
    Health Alliance Plan 21700 Northwestern Hwy Southfield, MI 48075Health Alliance Plan 2850 W. Grand Blvd. Detroit, MI 48202Henry Form OptimEyes Troy Super Vision Center 735 John R. Rd. Troy, MI 48303
    TAGS: Individual|Family|Purchasing|Enroll|Contact
  • Do I need to submit my premium payment with the online application form?
    If you are applying for coverage through HAP you have three payment options available to you. In the application process you can select credit card or EFT. The banking information must be included in the application process. Or, you can select the “bill me” option. A bill will be sent to you and will include the date that payment is due. You do not actually include a payment with your application.
    TAGS: Individual|Family|Purchasing|Enroll|Payment
  • Will my rate ever change?
    Rates are filed and approved through Michigan’s regulatory agency and approved on an annual basis. Outside of the formal rate approval process, members could experience an increase or decrease could occur to their rates if any of the following occur:
    • The family composition changes - new dependents are added or removed from the contract
    • The member moves to a new geographic location
    • The member switches plans due to a life event and the plan premiums are higher/lower than initial plan
    TAGS: Individual|Family|Purchasing|Enroll|Payment
  • What ages are eligible to apply for Personal Alliance Individual and Family Plans?
    Applicants can be enrolled in our products from newborn through 64 and 11 months of age. Dependents may apply for coverage on their parent’s contract prior to age 26. A 26 year can apply for coverage under his/her own contract. Stepchildren and legally adopted children who are legally dependent on the primary applicant are eligible to apply for coverage. When members reach age 65 they will be re-directed to a HAP Medicare product for coverage.
    TAGS: Individual|Family|Purchasing|Enroll
  • Could HAP ever cancel my policy?
    If you made false statements on your application, filed fraudulent claims, obtained duplicate coverage or failed to pay your premiums on time, HAP can cancel your policy. HAP cannot cancel your policy because of your health (current or previous) or claims history.
    TAGS: Individual|Family|Purchasing|Enroll|Cancel
  • Can I change my coverage at any time?
    For 2013 plans a Personal Alliance member cannot come in and out of coverage multiple times within a year. If a member was enrolled in a Personal Alliance product within the past 12 months, they cannot drop and add coverage within the same benefit period.

    For 2014 plans a personal Alliance member can change coverage during the open enrollment period each year. There are exceptions for enrollment or a change in coverage within 60 days of a life-changing event, such as the loss of a job, salary change, death of a spouse or birth of a child.
    TAGS: Individual|Family|Purchasing|Enroll

Group Plans

  • What are the cost sharing options for HAP plans?
    We offer HMO, PPO and EPO plans with a variety of cost-sharing options. Plans can include copays, coinsurance and/or a deductible.
    TAGS: Group|Coverage
  • What are the funding arrangements for HAP plans?
    Our HMO plans are community-rated and our PPO/EPO fully insured plans are experience-rated. The self-funded plan is the fixed cost plus the claims expense less any stop-loss reimbursements
    TAGS: Group|Coverage
  • What is the HAP market area?
    The HMO market area includes the counties of the HAP nine county market area:
    • Genesee
    • Lapeer
    • Livingston
    • Macomb
    • Monroe
    • Oakland
    • St. Clair
    • Washtenaw
    • Wayne
    The PPO/EPO market area includes these 9 counties plus 15 more:
    • Arenac
    • Bay
    • Clare
    • Gladwin
    • Gratiot
    • Huron
    • Iosco
    • Isabella
    • Midland
    • Ogemaw
    • Roscommon
    • Saginaw
    • Sanilac
    • St. Clair
    • Tuscola
    TAGS: Group|Coverage
  • Are HAP plans Heath Savings Account compatible?
    Yes, Health Savings Accounts (HSAs) are an optional feature for all of our HMO, PPO and EPO plans.
    TAGS: Group|Coverage
  • Who do I call for claims inquiries?
    The HAP claims department is available at (866) 766-4661.
    TAGS: Group|Claims
  • Who can I contact for customer service?
    Producers & Employer Groups with questions about member specific services should call (800) 950-7455 or email hap_direct@hap.org 8 a.m. to 5 p.m. Monday through Friday.
    TAGS: Group|Customer Service

Miscellaneous

Health Care Reform for Group and Personal Alliance Individual and Family Members

  • I've heard that the government has delayed parts of health care reform. How will that affect me?
    None of the provisions affecting individual consumers – adults under 65 who do not have access to health insurance through an employer – have been delayed.
    TAGS: Family|HCR|Individual
  • I want to keep my HAP health insurance, but my employer is switching to another health plan. Can I stick with HAP by getting my coverage through the Health Insurance Marketplace instead?
    You can purchase HAP coverage from the Marketplace, but because you have access to coverage through your employer, you will not be eligible for financial assistance. With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.
    TAGS: Family|HCR|Individual
  • My company offers health insurance to its employees, but I've chosen to be uninsured because it's too expensive. Can I get more affordable coverage from the Marketplace instead?
    If you have access to health insurance through your employer, you can shop for coverage through the Marketplace, but you will not be eligible for financial assistance. With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.
    TAGS: Family|HCR|Individual
  • I'm getting health insurance through my company, but there are rumors they might drop it because of health care reform. What will happen to me if my company drops health coverage?
    If your company drops health insurance for employees, you will be able to buy individual or family coverage, either directly from a health plan like HAP, or through the Health Insurance Marketplace. And, low- and middle-income individuals and families may be eligible to receive financial assistance through the Marketplace.
    TAGS: Family|HCR|Individual
  • I'm young and healthy and don't need a lot of health insurance. Can I buy limited coverage to save money?
    The Health Insurance Marketplace will offer, for individuals only, a catastrophic health plan that will cover the Essential Health Benefits, but only after a high deductible is met. Members won't have to pay the deductible for preventive care or for up to three primary care visits per year. Eligibility for the catastrophic health plan is restricted to either (1) young adults under age 30 prior to the start of the plan year or (2) individuals who get a "hardship exemption" from the Marketplace because they're unable to afford any other available health coverage.

    The monthly premium should be lower than other health plans offered in the Marketplace, but the out-of-pocket costs for copays, deductibles, and coinsurance are higher. In addition, catastrophic plans don't qualify for the premium savings and lower out-of-pocket costs that are available to low- and middle-income individuals through the Marketplace, so it's important to carefully compare all options.
    TAGS: Family|HCR|Individual
  • What is a “grandfathered plan” and how do I know if I have one?
    Grandfathered plans are those that were already in place on March 23, 2010, when the health care reform law was enacted, and that have stayed largely the same since that time. Grandfathered plans are exempt from some health care reform provisions. For example, a grandfathered individual plan does not have to guarantee coverage for people with pre-existing medical conditions or end yearly dollar limits on coverage. However, it's important to note that some grandfathered plans may offer benefits that are not required.

    Even if you joined a plan after March 23, 2010, the plan may still be grandfathered. The status depends on when the plan was created, not when you joined it. You can find out if your plan is grandfathered by checking your plan’s materials. Health plans must disclose if they are grandfathered in materials describing plan benefits. You can also check with your employer or your health plan’s benefits administrator.
    TAGS: Family|HCR|Individual
  • I am an American Indian or Alaskan Native; can I get help with my insurance costs?
    A consumer who is a member of a federally recognized Indian tribe may also be eligible for special cost-sharing rules. Certain American Indians and Alaska Natives who purchase health insurance through the Exchange do not have to pay co-payments or other cost sharing if their income is under 300 percent of the FPL, which is roughly $70,650 for a family of four in 2013 ($88,320 in Alaska).
    TAGS: Family|HCR|Individual
  • Can I get financial help paying for my Medicare coverage?
    Although the premium savings in the health care reform law don't apply to Medicare, there are a number of financial assistance programs available to help you pay your Medicare expenses if you are elderly or disabled with low income and limited assets. To find out if you might qualify, you should call your local Department of Human Services (DHS) office (in the telephone book under County Government or State Government) or look for your local DHS office online at www.michigan.gov/dhs (You are leaving choosehap.org) DHS will send you an application, or it can be found and printed online at www.michigan.gov/dhs (You are leaving choosehap.org).
    TAGS: Family|HCR|Individual
  • I lost my job and I'm getting COBRA coverage, but it's very expensive. Will I be able to get less expensive coverage through health care reform?
    If you are getting COBRA coverage, you may find that there are already lower-cost individual health insurance options available to you through HAP.

    Starting in 2014, health care reform will include financial assistance for low- and middle-income individuals who qualify based on their income and family size. Financial assistance will be available only through the new Health Insurance Marketplace, which will offer a wide variety of health plans, including HAP plans. If your COBRA coverage runs out or if you choose to end it, you will be able to change from COBRA coverage to Marketplace coverage at any time, even if it's not during the annual open enrollment period.
    TAGS: Family|HCR|Individual
  • Under health care reform, who is going to be making decisions about the care I need?
    As is now the case, you will be able to choose from a wide variety of private health plans, and decisions about your care will be made by you and your doctor.

    Your coverage for the care you receive will depend on the kind of health plan you choose. Your health plan will provide you with a detailed description of what is covered and what is not, along with a simplified Summary of Benefits and Coverage (SBC) that includes information on copays, coinsurance, and deductibles. The SBCs include examples of how much a member would typically pay in out-of-pocket costs for two medical scenarios: childbirth and treating type 2 diabetes.

    The Affordable Care Act guarantees your right to appeal a health plan decision. Private insurance plans have to tell you why a claim has been denied and they have to let you know how you can dispute their decision.
    TAGS: Family|HCR|Individual
  • I think I’m eligible for reduced costs, but the government says I’m not. What should I do?
    Keep in mind the ranges given on this page are a guide – other factors are taken into consideration when you apply, such as what county you live in, your exact age and income level.

    Make sure you entered accurate information. If you’re unsure of whether or not you’re using your correct income level, talk with a tax professional.
    TAGS: reduced costs
  • What if my income changes?
    You must report any income changes to the Marketplace as soon as you are able. Changes in income could change the coverage or savings you’re eligible for. You could have to pay back some or all of the tax credit you have received, or you could qualify for a higher tax credit.

    You can report income changes online by logging in to your account on HealthCare.gov and choosing “Report a Life Change.” Or, you can call the Marketplace at (800) 318-2596 (TTY: 1-855-889-4325).

    TAGS: reduced costs
  • What if I have health insurance through an employer?
    Most people with job-based health insurance are not eligible for lower costs. You may be eligible if your share of the premium for an employer-provided health plan that covers only you (the employee) – not other members of your family – is more than 9.5% of your family’s income.
    TAGS: reduced costs
  • Who do I call if I have questions about my eligibility for lower costs?
    If you have a question, you can call the Health Insurance Marketplace at:

    (800) 318-2596
    TTY: 1-855-889-4325

    The Health Insurance Marketplace is available 24 hours a day, 7 days a week. It is closed Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas.
    TAGS: reduced costs

Contact Us

  • How do I schedule a private consultation with a HAP representative?
    HAP representatives are available by phone, email and in person for one-on-one assistance to answer your health insurance questions and assist with on-the-spot enrollment.

    Call a HAP representative at (888) 899-4459 (TTY: 711)
    Monday – Friday 8 a.m. to 7 p.m.
    Saturday 9:00 a.m. to 5:00 p.m.


    Or, visit us at any of our walk-in locations:

    HAP Corporate Customer Service Lobby
    2850 West Grand Blvd.
    Detroit, MI 48202
    Mon – Fri 8:30 a.m. – 4:30 p.m.

    HAP Tower 14 Customer Service Lobby
    21700 Northwestern Hwy.
    Southfield, MI 48075
    Mon – Fri 8:30 a.m. – 4:30 p.m.
    TAGS: Contact|Customer Service

Detroit Public Schools Health Engagement FAQs

Using Your Group and Personal Alliance Individual and Family Health Care Coverage

  • How is individual health insurance different from insurance through an employer?
    Insurance you get through an employer is called “group” health insurance, meaning the rates are determined based on everyone in the group. Individual and family health insurance rates are calculated much like your car insurance – they're based on the people covered. HAP quotes take into consideration your age, where you live, tobacco use, and family composition.
    TAGS: Family|Individual|Plans
  • How do I check to see if my doctor and/or hospital are in the HAP network of providers?
    Use our online provider search (You are leaving choosehap.org) to see if your doctor(s) and/or hospital are in the HAP network. View the provider details to ensure that your doctor accepts your plan type.
    TAGS: Doctors|Family|Individual
  • What programs does HAP offer for weight loss?
    HAP offers a wide range of weight management programs for members to choose from (participation is voluntary):
    • Weight Watchers at $50 per 12-week session (up to four sessions per lifetime)
    • Clinical weight loss programs (several hospital-based weight management programs are covered by HAP when referred by a physician)
    • Nutrition Counseling
    • Weight loss medications
    • Online health resources
    • Online wellness program called iStrive® BALANCE®
    TAGS: Family|Individual|Weight Loss|Wellness
  • What smoking cessation programs does HAP offer?
    HAP offers several programs to help members quit smoking. While you are not required to quit in order to have HAP coverage, rates may be lower for non-smokers.

    Our smoking cessation programs include:
    • Smoking (tobacco/nicotine) cessation counseling services provided by your doctor
    • Henry Ford Medical Group's Smoking Intervention Program (SIP)
    • Henry Ford Health System Freedom from Smoking
    • Prescription and over-the-counter tobacco/nicotine cessation drugs or products, such as patches, gum, nasal spray or inhaler
    • Electronic counseling services with the iStrive® BREATHE® program
    TAGS: Family|Individual|Smoking|Wellness
  • How soon can I see a doctor once I apply?
    You can see a doctor on your effective date of coverage. Coverage will be active once the application is processed and full approved and premiums payments are received.
    TAGS: Coverage|Doctors|Family|Individual
  • Do I need to choose a primary care physician (PCP)?
    As an HMO member, you are required to select a HAP-affiliated PCP to manage your health care. A PCP will coordinate your medical treatment whether it is lab work, x-ray services or specialty care. It is important to develop a relationship with a PCP so that he/she learns your medical history and can provide you with the most appropriate and effective health care.
    TAGS: Coverage|Doctors|Family|Individual
  • Would I need a referral to see a specialist?
    If you have an HMO plan, your PCP will direct you to specialists when needed. HAP has simplified access to specialty care, providing paperless referrals and reducing the need for most referrals. For PPO plans, you do not need a referral.
    TAGS: Coverage|Doctors|Family|Individual|Referrals
  • How would I transfer my prescription to HAP coverage?
    To begin a prescription on your HAP coverage you should first finish your existing prescription as directed by your doctor. When you are ready for a refill or need to start a new prescription contact your HAP doctor. Be sure to provide your HAP ID card at the pharmacy.
    TAGS: Coverage|Family|Individual|Prescriptions
  • Where could I get my prescriptions filled?
    HAP is affiliated with many local and national pharmacies, including Target, Kroger, Meijer, CVS, Rite Aid and Walgreens. To find a pharmacy use our online pharmacy directory. (You are leaving choosehap.org)
    TAGS: Coverage|Family|Individual|Prescriptions
  • Will I have emergency or urgent coverage when I’m away from home?
    Yes. Emergencies and urgent care services are covered worldwide. HAP also offers members’ access to Assist America® which provides global emergency and other services for members who are traveling more than 100 miles from home or to another country.
    TAGS: Coverage|Family|Individual|Travel
  • My child is away at school – will he/she be covered?
    Your student is covered through HAP's Students Away program. Also, students covered by HAP have access to Assist America when they are 100+ miles away from home or in another country for less than 90 consecutive days. Emergency services and urgent care are always covered.
    TAGS: Coverage|Family|Individual|Student|Travel
  • Are services covered outside of the HAP network?
    Urgent care or emergency services are covered worldwide. Routine services are covered within the HAP network. Services outside the network may be covered if you have a PPO plan
    TAGS: Coverage|Family|Individual
  • What would happen if I change to HAP from another health care plan while I am in active treatment plan?
    HAP's Continuity of Care program allows members to continue to receive medical care from their current health care provider if you are currently involved in an active, covered treatment plan that if interrupted, could seriously affect your health.

    New members should contact our Client Services department to begin the process at (800) 422-4641. HAP will transfer you to an affiliated provider when possible, without disturbing the care being provided through your current treatment plan.
    TAGS: Coverage|Family|Individual

Health Care Reform for Small Groups

  • What taxes and fees apply to businesses with 50 or less eligible employees?
    On January 1, 2014, major provisions of the Affordable Care Act (ACA) that expand access to health coverage for the uninsured took effect, along with new taxes and fees included in the law. The following taxes apply to businesses with 2-50 eligible employees:
    • Health Insurance Premium Tax – An excise tax assessed on all fully insured health plans to help fund the provisions of the ACA
    • Transitional Reinsurance Program Fee – Funds a temporary program (2014-2016) intended to stabilize premiums for coverage in the individual market as high-risk individuals become newly insured; the program fee applies to fully insured and self-funded plans
    • Patient Centered Outcomes Research Institute (PCORI) Fee – Funds the PCORI, which will produce and promote research on clinical effectiveness to help patients and their health care providers make more informed health care decisions; applies to fully insured and self-funded plans
    • Risk Adjustment Fee – An annual assessment for the administration of a risk adjustment program that will transfer funds from plans with membership that is healthier than average to those with membership that is less healthy than average, in order to reduce the impact of adverse selection; applied to non-grandfathered small groups
    • Exchange User Fee – An assessment on insurers for all plans sold through a health insurance exchange. It will be applied to premiums of non-grandfathered small groups
    • Health Insurance Claims Assessment Act (HICAA) Tax – A tax applied to certain health insurance claims paid for services provided on or after January 1, 2012 that helps to support Michigan’s Medicaid program; applies to fully insured and self-funded plans
    TAGS: Group HCR Promo Tile|HCR|SmallGroup|Taxes
  • What is considered a “small” business?
    Small business health plans issued or renewed on or after January 1, 2014 are defined in two ways.
    • On the Health Insurance Marketplace, a small business is defined as 1-50 full-time equivalent employees
    • If the business is renewed through HAP (or an insurance agent), the State of Michigan regulations apply, which defines a small business as 2-50 eligible employees
    TAGS: Group HCR Promo Tile|HCR|SmallGroup|Student|Taxes
  • How have the rating rules changed?
    All Qualified Health Plans for small businesses issued or renewed in 2014, must comply with the Affordable Care Act’s new, adjusted community rating rules.
    Premium prices can be determined using the following four factors:
    1. Per Member/Per Month (PMPM) rating – Premium cost by member, rather than tiered contract, capped at the three highest priced dependents, not including spouse or dependents 21 or older
    2. Geographic rating – Michigan has defined 16 geographic areas in the small group market (rates will be based on the primary zip code of the business)
    3. Age rating ratio – Members of a small group, age 21 and older, cannot be charged more than three times the rate of a younger person for the same policy (HAP will use a prescribed age curve for ages 21 to 64)
    4. Tobacco ratio – Tobacco users cannot be charged more than 1.5 times the non-tobacco users’ price

    Note that these factors do not include health status, gender or industry type.
    TAGS: Group HCR Promo Tile|HCR|SmallGroup|Taxes
  • Who is responsible for paying taxes and fees for fully insured employers?
    Fully insured employers are those that offer health coverage for their employees from a health insurance company, like HAP. The employer pays a per employee premium directly to the health insurance company. All health insurance taxes and fees are included in the cost of coverage and paid by HAP. The taxes and fees may display on the invoice as separate line items or embedded in the premium, based on the employer’s preference.
    TAGS: Fully insured taxes

Health Care Reform Tax Questions for Large Groups

  • What taxes and fees apply to businesses with 51 or more eligible employees?
    On January 1, 2014, major provisions of the Affordable Care Act (ACA) that expand access to health coverage for the uninsured took effect, along with new taxes and fees included in the law. The following taxes apply to businesses with over 50 eligible employees:
    • Health Insurance Premium Tax – An excise tax assessed on all fully insured health plans to help fund the provisions of the ACA
    • Transitional Reinsurance Program Fee– Funds a temporary program (2014-2016) intended to stabilize premiums for coverage in the individual market as high-risk individuals become newly insured; applies to fully insured and self-funded plans
    • Patient Centered Outcomes Research Institute (PCORI) Fee – Funds the PCORI, which will produce and promote research on clinical effectiveness to help patients and their health care providers make more informed health care decisions; applies to fully insured and self-funded plans
    • Health Insurance Claims Assessment Act (HICAA) Tax – A tax applied to certain health insurance claims paid for services provided on or after January 1, 2012; funds generated by the assessment will support Michigan’s Medicaid program; applies to fully insured and self-funded plans
    TAGS: Group HCR Promo Tile|HCR|Individual|LargeGroup|Student|Taxes
  • Who pays health insurance taxes and fees for self-funded employers?
    With a self-funded plan, employers pay for health claims themselves; HAP manages the plan and administers claims. Employers in a self-funded plan are responsible for paying all taxes and fees.
    TAGS: Paying Taxes
  • Who is responsible for paying taxes and fees for fully insured employers?
    Fully insured employers are those that offer health coverage for their employees from a health insurance company, like HAP. The employer pays a per employee premium directly to the health insurance company. All health insurance taxes and fees are included in the cost of coverage and paid by HAP. The taxes and fees may display on the invoice as separate line items or embedded in the premium, based on the employer’s preference.
    TAGS: Paying Taxes

Detroit Public Schools Health Alliance Plan FAQs

  • Do I need to select a primary care physician (PCP)?
    As an HMO member, you are required to select a HAP-affiliated PCP to manage your health care. A PCP will coordinate your medical treatment whether it is lab work, x-ray services or specialty care. It is important to develop a relationship with a PCP so that he/she learns your medical history and can provide you with the most appropriate and effective health care.

    Reminder: if you elect one of the DPSCD core plan options you and your spouse must select your PCP from the HFPN network.
    TAGS: HAP FAQ
  • How do I select a PCP?
    If you do not have a PCP, there are several methods for selecting one:

    Visit our Search for a Doctor or Facility (You are leaving choosehap.org) tool.

    Call our automated services line toll-free at: (877) 427-3678 and press option 4 (you can make PCP changes 24 hours a day with this line). You will need to know the PCP's Physician Code when you call. This information can be found in the Search for a Doctor or Facility (You are leaving choosehap.org) tool or in your Provider Directory.



    Call a PCP Selection Specialist toll-free at: (888) PIC-A-PCP (888-742-2727)

    TAGS: HAP FAQ
  • How can I find out if my physician is affiliated with HAP?
    We have over 2,700 PCPs affiliated with us, so there is a good chance your physician is already with us! To make sure your physician is HAP-affiliated, check out our Search for a Doctor or Facility (You are leaving choosehap.org) tool and enter the physician's name. If you don't see your physician listed, contact us about having him/her join the HAP family of physicians.
    TAGS: HAP FAQ
  • How do I see a specialist?
    When specialty services, beyond routine OB/GYN care, are medically necessary, your PCP will direct you to a specialist.
    TAGS: HAP FAQ
  • What is a “medical center”/”hospital affiliation”?
    When you select a PCP, you become part of that PCP's medical center/hospital affiliation/PO/PHO. A medical center is made up of many physicians (PCPs and specialists) who are under one roof and create a one-stop shop for services. A hospital affiliation describes providers grouped together to serve you. These providers work in private offices and may also include a hospital that is linked. Both terms refer to the team of physicians that you will seek all care from, routine and specialty.
    TAGS: HAP FAQ
  • What about emergency services?
    You have worldwide coverage for emergency services, so around town or around the country you are covered. You don't need to call us, just go to the nearest emergency room or call 911 for assistance. If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card.
    TAGS: HAP FAQ
  • Are referrals required for specialty care?
    Sometimes you may need a medical service beyond what your PCP can offer in their office. When specialty services are medically necessary, your PCP will direct you to a specialist. Your PCP coordinates your care, sees to your needs and keeps your medical history up to date. When you choose your PCP, you’re also choosing your network of doctors for specialty care. If you select the DPSCD Premium plan and choose a PCP in the Detroit Medical Center, the Henry Ford Medical Group, ACCESS or Genesys network, you will receive specialty care from doctors within that network. If you choose a PCP in any of our other networks, you can see specialists in any HAP network.
    TAGS: HAP FAQ
  • Do I need written direction to see a specialist?
    Most physicians are participating in a “paperless” system when directing their patients to a specialist. This means you will not have a physical piece of paper to take to the specialist. Don’t worry! As long as you have started the process with your PCP and the service is a covered benefit for you, there will not be any issues.
    TAGS: HAP FAQ
  • If I request to see a provider that my PCP is not familiar with, what can I expect to happen?
    HAP encourages you to continue to discuss your care preferences with your physician. More than ever before, members have the opportunity to work in partnership with their physicians. This allows you to understand treatment options and to make joint decisions regarding how and where to obtain high quality, cost effective care and services in a timely manner that will best meet your needs and expectations.
    TAGS: HAP FAQ
  • Do I need to coordinate emergency follow-up care with my PCP or can I take the direction of the ER?
    All follow-up care after an urgent or emergent encounter should be coordinated through your PCP.
    TAGS: HAP FAQ
  • Address Change: I recently moved. What is the easiest way to change my address?
    The quickest and easiest way to change your address is on our Web site. Here you can update your mailing and e-mail address. For security reasons, newly registered members will be unable to change their address for five business days after registering for HAP Web site access. Be sure to inform your employer (if applicable) and physicians of your address change as well.
    TAGS: HAP FAQ
  • Benefit Information: Do I need to inform HAP if I have other health insurance?
    Yes. Use Coordination of Benefits to update your information regarding other health insurance.
    TAGS: HAP FAQ
  • Where can I get a summary of my benefits?
    Most employers provide a summary of benefits to employees. Contact your employer's benefits office to request a copy. You may also access this information. You can view a benefit summary or your Subscriber Contract and riders.
    TAGS: HAP FAQ
  • Claims: Will I have to submit claims for any services I receive?
    As a HMO member, you will only see a bill for any cost-sharing responsibilities you may have.

    For example, if you see your physician for an annual checkup, your physician will bill us and you would just pay your copay, co-insurance or portion of your deductible. If, however, you have an emergency while out of our market area, you may be required to pay for services up-front and submit a claim for reimbursement. If this happens, you would simply mail a copy of the claim to us.
    TAGS: HAP FAQ
  • How can I check the status of my claims?
    You can check the status of your claims on our Web site. You'll be able to access medical and pharmacy claims from the last 18 months.
    TAGS: HAP FAQ
  • What should I do if I receive a bill incorrectly from a provider?
    If you receive a bill, contact Client Services or use the Get Help with a Bill Tool.
    TAGS: HAP FAQ
  • Can I e-mail HAP if I have a question about a claim?
    To ensure that your privacy is protected, we recommend that you use our Customer Message Center to send us your question.
    TAGS: HAP FAQ
  • Students Away At School: My child will be going away to school in the fall. Is he/she covered while away?
    Yes, your child is covered through HAP's "Students Away" program.
    TAGS: HAP FAQ
  • If my child requires outpatient counseling while out of state at school, is he covered through HAP's "Students Away" program?
    No. Your child would not be covered for outpatient counseling while he/she is away at school. Only emergency psychiatric services would be covered for him/her while away at school. Routine counseling services must be provided by a HAP-contracted provider though our Coordinated Behavioral Health Management team.
    TAGS: HAP FAQ