Q. Is HealthChoice an insurance?
A. No, it is a program. The group employer selects one of three, participating health care providers who extend limited benefits for most needed health services, including physician office visits, urgent care centers, lab x-ray, mammograms and prescription medication.
Q. Who are the health care providers?
A. The current list includes Community Care Partners, Midwest Health Plan and Pro Care Plus. They were chosen in a countywide bidding process.
Q. Can I find quality doctors in the network?
A. Yes. HealthChoice reviews the qualifications of participating physicians and clinics to assure the medical delivery meets its standards. The health plans look to work with other doctors and health facilities throughout the county and region to serve its member base.
Q. What are my out-of-pocket costs?
A. Members have a $10 co-pay for doctor visits, $20 for specialist visits, $50 for hospital emergency room visits in the network, $100 for hospital visits outside the network. If admitted, emergency room fees are waived, but ER visits are only covered if the condition is deemed life threatening. The plan encourages people to visit an urgent care facility in their network that charges a $15 co-pay.
Q. Can I go anywhere in the health network as needed?
A. No. You select a primary care physician (PC). If you need to be treated by a specialist, then you obtain a referral from your health care provider.
Q. How do I assure that my claims will be paid?
A. HealthChoice maintains a reserve fund to pay claims in a timely fashion if a HealthChoice client's validated claim is not paid in a timely manner. Please use our†contact form to reach the organization if you have any questions or comments.
Q. What services are excluded from coverage?
A. For comprehensive answers, please see the HealthChoice handbook. Among the services declined are sickness and injury arising out of an employment activity or motor vehicle accident. It wonít cover any medical condition arising out of a memberís action in conjunction with the commission of a felony or for any form of self-inflicted injury. It doesnít pay for experimental treatments, chiropractic care or, cosmetic surgery.
Q. How can the firm qualify for supplemental benefits?
A. Individuals cannot select their own health riders. The company selects the riders for its whole group. Options include physical therapy, durable medical equipment, vision exams and glasses, inpatient drug and alcohol rehabilitation services and an additional 10 inpatient hospital days.
Q. Is it necessary to pay the premiums on time?
A. Yes. Failure of the employer group to pay the entire monthly premium by the due date could cause all subscribers and their eligible dependents to lose covered services for the month the premium was due. It could result in cancellation of the group. They may have to wait months to re-enroll.
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