FAQ’S REGARDING HAP EMPLOYEE DEDUCTIBLE AND CO-PAYMENTS
Posted July 26, 2011
Dear Guild Members:
When the new HAP health insurance coverage went into effect 1-1-11, the Guild, in co-operation with Health Alliance Plan, distributed an FAQ to address initial questions regarding the new front-end $300/$600 deductible. This follow-up FAQ focuses on some initial confusion as to what constitutes a “preventive service” that is exempt from the new deductible. We have distributed an updated HAP Summary of Benefits for your policy, which has the new benefit code L4A.
Q-What is the annual deductible? How does it work?
A-The annual deductible is a $300. charge for an individual and $600. for a family. This annual fee must be paid by the employee before health coverage begins for most medical services including treatment of chronic conditions. The only exceptions are for: Preventive office visit; Well Baby office visit; Immunizations; Related Lab and Radiology services; and Pap smears and Mammograms.
Q-I have a chronic condition and must see my specialty physician periodically for exam and treatment. Does this office visit require the deductible to be paid before insurance coverage begins for these appointments?
- Yes. The annual deductible DOES APPLY regarding treatment for chronic conditions, such as heart disease, Rheumatoid Arthritis, Diabetes and other illnesses that require periodic evaluation or treatment. This deductible includes lab work, medical equipment or other diagnostic tests.
For example: You must see your Cardiologist for an exam as part of your ongoing care for a chronic condition. The doctor’s fee is $100. You must pay the full $100. and it will be applied to your $300. deductible. You then have two other visits to your Cardiologist and the bills again are $100. per visit. You must pay the full amount until you reach the $300. deductible.
After reaching the $300. threshold, any additional visits to your Cardiologist will be $50. as part of your HAP co-pay for seeing a specialist. The annual deductible has been met. The same formula applies for seeing your Primary Care Physician (PCP).
Q-As part of my chronic condition, I must have monthly blood tests. Does the annual $300. deductible apply for these tests?
- Yes. You must pay the full amount for the blood tests until you have reached the annual $300. deductible. Afterward, blood tests and other outpatient treatments are covered by your HAP insurance. Medical bills are cumulative so that both physician exams and treatments go toward meeting your $300. deductible.
If you have further questions, refer to the orange colored HAP Summary of Benefits, or call HAP at: 313-872-8100 or toll-free (800) 422-4661. Office hours are Monday thru Friday
7 a.m. to 7 p.m. and Saturday 8 a.m. to Noon. Your Unit Chairperson also has copies of the HAP summary.
