Typically clinics can be found inside of stores or pharmacies, like the Minute Clinic at CVS. Clinics are great for simple health issues such as earaches, colds, coughs, strep throat, flu shots, etc. They are usually staffed by Nurse Practitioners or Physician Assistants making them an economical option for your more routine health care needs.
These clinics are generally required to have a doctor on-site. This allows them to treat a wider variety of injuries and illnesses such as upper respiratory infections, minor burns, sprains, cuts, and rashes. Simple lab tests and x-rays can often be done, but urgent care clinics should not be used for chronic conditions or emergency situations.
An emergency room should be used for life-threatening or serious situations that may require a specialist or advanced testing. These situations may include heart attacks, strokes, serious injuries, extensive burns, or loss of consciousness. ER visits are generally the most expensive option, so it is best to save for extreme circumstances only.
Our provider directory helps you to find a doctor or a facility. Please be aware that this information is updated on a regular basis. 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 ID card at each visit.
If your card has the PHP logo and purple coloring, Physicians Health Plan is your healthcare insurance company.
If your card is black and white with your company's name, 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.
If you prepare your own taxes
Do NOT attach the form or send it with your taxes; keep it with your other important tax papers. If the form shows insurance for you and everyone listed on your tax return for the entire year, check the full-year coverage box on your tax return (located on line 61 of Form 1040, line 38 of Form 1040A or line 11 of Form 1040EZ).
If there are months when you or your family members did not have insurance you may be able to find helpful information at: https://www.irs.gov/Affordable-Care-Act/Questions-and- Answers-about-Health-Care-Information-Forms-for-Individuals. You may qualify for an exemption or you may have to make an individual shared responsibility payment.
If you don’t prepare your own taxes
Share the 1095-B form with your tax preparer.This will help them to file your taxes properly. Your 1095-B form is not required to file your taxes, however check with your tax preparer for their documentation requirements.
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.
If your form has your Social Security Number (SSN)
Your SSN will be used to verify MEC against your tax return, so you will not need an updated form. However, for PHP's electronic transmission, your name must be submitted exactly as it has been registered with the IRS. Please contact PHP's Customer Service Department at 1-800-982-8257 to update your information.
If the form does NOT contain your SSN and therefore cannot be verified, please contact PHP’s Customer Service Department at 260-432-6690, Extension 16. We will update the form and send you a new form with your updated name.
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.
Explanation of Benefits
Maybe you've received an Explanation of Benefits (E.O.B.) in the mail and are wondering how to interpret it. Don't worry - Kim also received an E.O.B. after a trip to the ER and it was really helpful. It's a simple explanation of the services you received and how much PHP covers.
Simply show your PHP ID card at one or more of the following organizations and receive a variety of special discounts just for being a PHP member. That's PHP Easy!
- FitZone for Women
- Parkview Health & Fitness
- Fort Wayne Children’s Zoo
- Catalyst Fitness