Not your ordinary HMO plan
HAP Senior Plus HMO-POS (Medicare Advantage Plan)
The Senior Plus HMO-POS plan provides members with medical, pharmaceutical, vision and hearing coverage through the HAP HMO network with $0 monthly contribution. In-network coverage while traveling in any of the 49 states outside of Michigan. The Enhanced Travel Benefit allows members to seek care for plans covered benefits with any Medicare participating provider for the same cost share as in-network.
HAP HMO-POS (Non-Medicare Plan)
The HAP HMO-POS Non-Medicare plan provides members with medical, pharmaceutical, vision and hearing coverage through the HAP HMO network with $0 monthly contribution. The POS plan gives members the option to choose from providers inside or outside of the HMO network. Generally, in-network care will cost the member less. Out-of-network care will subject members to higher cost share. POS coverage includes all 49 states.
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 (ENT). 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.
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.
Health Alliance Plan (HAP) has HMO-POS plans with Medicare contracts. Enrollment depends on contract renewal.