HMO Plans
Plus Plans
POS Plans
PPO Plans
TPA Plans
Coordinated Care Plan (CCP)
Health Reimbursement Arrangements
Flexible Spending Accounts
COBRA Administration
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Health Alliance Plus plans allow employers to determine the level of coverage.
With Plus plans, members can seek treatment from the physician of their choice,
but coverage is greatest in the Health Alliance network of providers. The physicians,
hospitals and pharmacies in our network are all chosen because of their reputation
for excellence. Below is a summary of how our Plus plans typically work.
If you have questions about our Plus plans, Contact Us.
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In-Network/Out-of-Network Coverage: Plus members can receive
health care services from the physician of their choice and benefit levels are developed are
determined by that choice. Health Alliance arranges for discounts within our provider network.
Coverage and cost savings are greatest when an in-network provider is chosen.
When an out-of-network provider is a chosen, the member is responsible for a greater portion
of the cost.
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Primary Care Physicians: Plus members select an
in-network primary care physician (PCP) to coordinate in-network care. Although members
are not required to see their PCP, it is encouraged that they establish an ongoing
relationship with a physician. Members can change their PCP at any time by calling
our Customer Service Department.
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Referrals and Authorizations: Because the Health Alliance
network is so extensive, most specialty care can be obtained within the network,
where it is covered at a higher in-network benefit level. If needed specialty care is not
available in our network, the member’s PCP will review the case with a Health Alliance
Medical Director to determine if your care can be covered at the in-network benefit level.
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Prescription Drug Coverage Option: Employers may choose
to offer prescription drug coverage as part of the Plus benefit package. Typically,
prescriptions require a copayment at the time they are filled.
Most packages offer a “tiered” prescription benefit where the prescription selected
determines how much the member pays.
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Out-of-Pocket Maximums: In the event of a catastrophic
illness or injury, Health Alliance has placed a limit on the member’s personal expenses.
After a member has reached their limit, all covered medical expenses are paid by Health Alliance
until the beginning of the next benefit year. Out-of-pocket maximum limits differ for in-network
and out-of-network services.
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