Frequently Asked Questions

If an emergency occurs when you are traveling, you are covered with HealthPlus. If the illness or injury is minor, you may be asked to pay the bill up front. If you pay for the services you receive, submit the bill to HealthPlus as soon as possible, and you will be reimbursed consistent with HealthPlus policy.

If you need to have a prescription filled while you are out of the service area, HealthPlus is contracted with several nationwide chains, including Wal-Mart and K-mart. If you take your prescription to a nationwide chain listed in our Provider Directory, they should fill it at no cost to you except for any applicable copayment. However, sometimes out-of-state pharmacies may not be aware of the contract arrangement with HealthPlus, and may ask you to pay for the prescription when you pick it up. Again, submit the bill to us, as quickly as possible. You may also ask the pharmacy if they would be willing to call HealthPlus at 1-800-332-9161 to check on your coverage and accept payment from HealthPlus.

If a major illness or injury occurs while you are traveling, the hospital or provider should contact HealthPlus, and arrangements for payment may be made. You should not be involved in the payment process; however, if you do receive a bill for services, submit it to HealthPlus as soon as possible.

Remember, after-hours clinics are often readily available to handle minor illnesses and injuries when they occur, and they are less costly and require less waiting time than most hospital emergency rooms.

Eligible college students are covered for emergency illnesses or injuries that occur when they are out of the service area. HealthPlus does require college students to have their routine health care needs performed by their primary care physician in the service area. This would include physical exams, pap and pelvic exams, etc. If a minor illness or injury occurs while they are away at school, they may be asked to pay for the services up front. If this occurs, submit the bill to HealthPlus. Remember: any reimbursement will be made to the contract holder, so if the student is on your contract, you will receive the reimbursement.

If you have questions, the best thing for you to do is to call your child's college, and discuss their policies concerning health care coverage. Ask if they require payment at the time of services, if they would consider billing the health insurance carrier, etc. It will be much easier for you to get the information you need from the specific college, as
policies will almost certainly differ between schools.

When you choose a primary care physician, you are also choosing the hospital system that he/she uses. This is the hospital that is listed along with your primary care physician in the HealthPlus Provider Directory. In addition to using a particular hospital system, most HealthPlus primary care physicians also have certain specialists they prefer to work with. We can't guarantee the specialist you are currently seeing is one your primary care physician works with. The best thing to do is call the primary care physician you are considering and discuss your specific health care needs, including specialists that you are currently using. You may decide that you need to select a different primary care physician, or, you may agree with the primary care physician's recommendations for specialty care.

If your primary care physician determines that you require additional care by a specialist, he or she will initiate the appropriate HealthPlus referral process.

If you need a referral, you will receive either written notification from HealthPlus, or a referral form from your primary care physician, which will specify the number of visits and the length of time covered by this referral. If your referral expires and you need additional visits, contact your primary care physician.

If the specialist to whom your primary care physician is referring does not participate with HealthPlus, your primary care physician will initiate the out-of-plan referral process. Only services approved by HealthPlus prior to visiting an out-of-plan physician will be covered. You will receive a decision in writing, usually within five to seven working days from the time the referral is received by HealthPlus. If the referral to the out-of-plan specialist is not approved, HealthPlus will explain the reason for the denial. If you wish to appeal a denial, you may call Customer Service for information on the appeal process.