HEALTHCARE PLAN OVERVIEW
Our Healthcare Plan offers personalized health care based on the needs of the communities where our members live and work. We partner with a network of healthcare providers (doctors, hospitals, etc.) to provide a variety of services for a predetermined fee. In general, our members’ healthcare options are limited to our in-network providers. Furthermore, our stand-alone multi-specialty medical facilities and urgent care centers offer easy accessibility, convenience and relatively inexpensive medical care, with quick response times and flexible hours around the clock that available to a wider demographic.
Together, we are making significant progress in our mission to increase access to health benefits and improve healthcare for all citizens, whether you are an employer group seeking affordable benefits and quality healthcare for your employees, the self-employed, or individuals and families who may require health coverage for sick visits, hospitalization, procedures, diagnostic, pharmacy, dental, and vision services when and where they need them at the lowest possible cost.
Here’s a more detailed breakdown:
Billing: The Providers then bill the plan directly electronically or paper copy and the plan pays the healthcare providers.
Plan Contracts with Providers: Plan establish agreements with healthcare providers in the network, outlining the services they will provide and the fees they will be paid.
Members Choose Primary Care Physician (PCP): Plan members are required to choose a PCP, who serves as their (GATEKEEPER) primary point of contact for medical care.
PCP Coordinates Care: The PCP coordinates the member’s care, referring them to specialists within the network when needed.
Referrals: Members need referrals from their PCP to see specialists.
In-Network Care: Members receive coverage for services from providers within the network.
Payment: The plan pays the providers for the services they render to members.