• Is Physicians Health Plan my healthcare insurance company?
• How do I obtain healthcare services?
• How do I use Physicians Health Plan's network?
• Do I need to choose a primary care physician (PCP)?
• What should I do in case of an emergency?
• What if I need medical care that isn't available from a doctor participating in the network?
• How do I get more information?

Is Physicians Health Plan my healthcare insurance company?
 

If your card looks like the purple card at right, Physicians Health Plan is your healthcare insurance company.

If your card looks like the white card at right, Physicians Health Plan is not your healthcare insurance company. Your employer has a self-funded health plan and is financially responsible for payment of your benefits and determines what services are covered and at what benefit level. They have selected PHP Management Systems, Inc. (PHPMSI), a Third Party Administrator and a subsidiary of Physicians Health Plan, Inc., to manage and process medical claims on their behalf. Provider network participation may vary. Please refer to your Summary Plan Description or contact PHP's Customer Service Department for details.

How do I obtain healthcare services?

How do I use Physicians Health Plan's network provider directory?

This directory lists doctors by their specialty and by city. Please be aware that this information is updated on a regular basis, but a doctor's status sometimes changes. To be certain a doctor is participating, ask the office staff prior to receiving care, or call the PHP Customer Service Department. Always show your I.D. card at each visit.

Do I need to choose a primary care physician (PCP)?

Primary Care Physicians are defined by PHP as any of the following specialties: Family and General Practice, Internal Medicine, Pediatrics and OB/GYN. We recommend that a Primary Care Physician oversee the healthcare of all members for the best overall quality care; however, Physicians Health Plan's provider network is "open access." Therefore, no referral is needed to see participating specialists.

What should I do in case of an emergency?

PHP's definition of an emergency allows coverage for emergency room services that a reasonable person would consider dangerous to the patient's life or health. If a life-threatening medical condition occurs, call 911 or your local emergency service. If a non-life-threatening emergency occurs, contact your doctor for direction.

It is a good idea to discuss with your doctor what to do in the event of an urgent medical situation before it happens.

What if I need medical care that isn't available from a doctor participating in the network?

A referral to a non-participating doctor may be obtained if a uniquely specialized procedure is medically necessary and not performed by any participating doctors. This process must be requested by your participating doctor and approved by PHP, in writing, prior to receiving the services.