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Health Alliance Medicare Website


HMO Plans
Plus Plans
POS Plans
PPO Plans
TPA Plans
Coordinated Care Plan (CCP)
Health Reimbursement Arrangements
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COBRA Administration 		Health Alliance POS plans put members in control of their coverage in that their choice of provider determines their level of benefits. Care from providers in the Health Alliance network is covered at an HMO benefit levels with no deductibles and low, predetermined copayments for most services. The choice to go out of network is up to members and when they do, the care they receive is covered by indemnity benefits. Below is a summary of how our POS plans typically work. If you have questions about our Plus plans, Contact Us.

  1. HMO Benefits: When care is from a provider in the Health Alliance network, the member receives HMO benefits with no deductibles and low, predetermined copayments for most services.
  2. Primary Care Physicians: Health Alliance POS members should select a Primary Care Physician (PCP) from the network of Health Alliance physicians to coordinate all in-network care.
  3. Indemnity Benefits: When a member sees a provider outside of the network, they must first satisfy a deductible before indemnity benefits are available. After the deductible has been met by the member, they are required to pay a set percentage (coinsurance) on covered services.
  4. Preauthorization for Indemnity Benefits: Health Alliance requires certain out-of-network services to be preauthorized with the Medical Management Department before indemnity benefits are available. Elective hospitalizations, elective surgeries, skilled nursing facility admissions, home health care and hospice care all require preauthorization. A substantial penalty is assessed for care received without preauthorization.
  5. 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.
 


All contents © 2007 Health Alliance Medical Plans. All rights reserved. Every effort has been made to ensure that this information is accurate. It is not intended to replace the legal source. In case of any discrepancy between this information and the legal source, the legal source will govern in all cases.

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