Q. Will your plan send out detailed benefit information to employees?
A. Yes, HPS provides a comprehensive
benefits summary for each plan which describes coverage provisions to every subscriber. In addition, an
Evidence of Coverage is provided to every new enrollee within the group. Additional information is provided if the group enrolls in pharmacy and/or dental coverage. These documents are also available on our website for members to review.
Q. When does coverage begin?
A. Initial enrollees and eligible dependents are covered on the first day of the month following the employer group's waiting period.
Q. When traveling, can my employees receive coverage out-of-area?
A. Employees and their dependents are covered anywhere in the world for emergency services. All claims must be translated into English and any charges converted to U.S. dollars.
Q. What products and services do you offer?
A. We offer a wide array of medical and dental
insurance products and services for employer groups. A
complete list of products and services can be found by
clicking here.
Q. Does HPS offer prescription drug coverage?
A. Yes. HPS offers a variety of prescription drug plans. The benefit options include those plans with member copayments only for medications as well as those plans that pay all generics with a copayment only, while brand medications require a deductible be met before a percentage of the drug cost is paid by the plan.
HPS also offers an option for members to purchase their maintenance medications through a mail order pharmacy. Maintenance medications are those drugs that a member takes on a daily basis to control diseases such as hypertension, diabetes, high cholesterol, etc.
Q. Who must be notified of a change of address or other administrative change for the group?
A. HPS’s Sales Department at (706) 549-0549, ext. 2264.
Q. How do I change the waiting period on our group policy?
A. Send a written request for the change to your HPS Account Representative.
Q. What is the maximum waiting period a group can impose?
A. Six months.
Q. I have an employee out on disability. How long am I required to keep them on the group health insurance policy?
A. Continuation of a disabled employee's coverage is dependent upon your company's internal policies.
Q. What is a Primary Care Physician?
A. A Primary Care Physician (PCP) is the doctor your employee must choose to give and/or arrange all medical care. The PCP is the medical case manager for your employee.
Q. Which type of doctors should my employee choose as a PCP?
A. Family Practice doctors treat patients of all ages. Internal Medicine doctors generally treat patients over the age of 16. Pediatricians will treat children generally from birth to 18 years of age.
Q. Where do I find a list of Health Plan Selects PCPs?
A. The PCPs are listed in the directory that is
included in the enrollment kit and it is also available on
our Provider Directory.
Q. What should my employee consider before choosing a PCP?
A. Choosing a PCP is a personal decision. Before you decide, your employees may want to consider the following:
• Is the doctor's office near their home or work?
• Do the office hours meet their needs?
• Have they heard about the doctor from family or friends?
Q. Can my employees continue to see the doctor they were using before becoming a Health Plan Select member?
A. If their doctor is a primary care physician and is listed in our Provider Directory the answer is YES. We suggest they contact their physician to update any prior insurance information and provide their updated Health Plan Select information. For other questions related to specialists or providers outside the HPS network, please contact Member Services for direction.
Q. Does everyone in the family have to use the same PCP?
A. No. Each family member may choose their own PCP.
Q. Will my employees need to schedule an appointment with their PCP after enrollment if they are a new patient?
A. Yes, employees need to schedule an appointment to meet the PCP and go over their medical history. It is important to establish the doctor/patient relationship as soon as possible.
Q. Can a PCP be changed?
A. Yes. Members may change their PCP twice a year. The change will be effective the first day of the month following receipt of the request. A new ID card will be issued showing the change. Please contact Member Services or submit a change form to update the PCP.
Q. What if an employee needs to see a specialist?
A. The PCP will arrange all of the employee’s
care. If the PCP feels a visit to a specialist is needed,
they will refer the employee to an in-network specialist.
HPS does not need to be notified of a referral by the PCP to
an in-network specialist. An in-network specialist is
defined as those providers within our service area that have
signed contracts with HPS to provide specialty services to
covered members. A listing of these providers can be found
on our Provider Directory.
Q. Are there any exceptions to the rule that HPS does not need to be notified of a referral by a PCP to see an in-network specialist?
A. Yes. A referral is required for the following in-network specialists:
• Pain Management Providers
• Rehabilitation Services
• Home Health Services
• Physical, Speech and Occupational Therapy
• Durable Medical Equipment (DME) Providers
(Not an all-inclusive list. Call Member Services for any additional questions.)
Q. What if care is needed from a certain type of specialist not available in the Health Plan Select network?
A. This requires a written referral from the PCP to HPS
AND Prior-Authorization by HPS. There may be times when a certain type of doctor is not available in the Health Plan Select network. In those situations Health Plan Select and its Medical Directors will authorize treatment by an out-of-network specialist. When approved, benefits will be paid as if the doctor was in-network.
Q. What if my employee has an emergency?
A. An emergency is defined as a medical condition of a recent onset and sufficient severity, including but not limited to, severe pain that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in (1) placing the patient’s health in serious jeopardy, or (2) serious impairment to bodily functions, or (3) serious dysfunction of any bodily organ or part, or (4) with respect to a pregnant Member who is having contractions, that there is inadequate time to safely transfer her prior to delivery or that such transfer may pose a threat to the health or safety of the Member or her unborn child.
How will this be paid? For treatment of an illness or injury determined to be an emergency, the member will be responsible for the applicable emergency room co-payment listed on their benefit summary.
Q. What if my employee has an urgent problem, but it doesn’t meet the definition of emergency?
A. During regular office hours, employees should call their PCP. If necessary, an appointment will be made for that day or the following business day. The PCP may send the employee to an urgent care center or the emergency room.
HPS has three (3) urgent care centers with extended office hours. The facilities are called Regional First Care and they are located:
• Jefferson - 528 Panther Drive Jefferson, GA 30549
- Phone: (706) 387-5555
• North Athens - 485 Highway 29 North Athens, GA 30601
- Phone: (706) 353-6000
• Watkinsville - 1960 Experiment Station Watkinsville, GA 30677
- Phone: (706) 769-0000
Regular Business Hours
Monday - Friday: 8 am - 8 pm Saturday & Sunday: 10 am - 6 pm.
A referral is NOT required to visit the Urgent Care facilities.
Q. What if my employee is out of town and needs care?
A. If your employees are out of town and have a life-threatening or serious emergency, they should call 911 or go to the nearest hospital emergency room for treatment. Employees are also encouraged to utilize our 24-hour nurse line at 1-800-337-4770. Registered nurses are on call 24/7 to provide guidance to HPS members on how to handle emergency as well urgent medical situations. If members are directed to the ER by the nurse line, HPS is notified the next business day and an authorization is entered in the claims system to pay any related expenses.
Q. Up to what age are dependent children covered by the Health Plan Select plan?
A. Health Plan Select covers dependent children up to the age of 19. If they are a fulltime (minimum 12 hours) college student, they may be covered up to and including the age of 25. Verification of full-time student status is needed from the institution to extend benefits beyond age 19. Please see information in Section II –
Dependent Eligibility for more information.
Q. What if my employee has a child away at college, can they be covered on Health Plan Select?
A. If your employee is enrolled in the HMO plan their child is only covered for emergency care if they are outside the HPS Service Area. Follow up care for the injury will need to be obtained from a provider in the HPS network. If your employee is enrolled in the POS plan, the child can receive out-of-network benefits as well as emergency treatment. Follow up care can be obtained out of network, subject the out-of-network benefits (deductible and co-insurance).
Q. If my employee is divorced and responsible for the medical insurance for their dependent children, will the children be covered if they live out of the service area?
A. Employees who are court ordered to cover their children who live out of the service area may do so by enrolling in the Point of Service Plan. The HMO plan will only provide benefits for medical emergencies.
Q. Can my employee continue to cover their spouse on their medical coverage if court ordered to do so following a divorce?
A. Ex-spouses are not eligible for coverage under an employee’s health plan through HPS. Groups with 20 or more employees can be covered under the COBRA continuation of coverage provision and previously covered spouses are eligible for up to 36 months of additional coverage following a divorce. For groups with less than 20 employees divorced spouses will be eligible for Georgia Continuation of Coverage for up to an additional three (3) months of coverage.
