View Accessibility page

PHP partners with insurance brokers throughout our service area and beyond. If you are currently working with a broker and would like to learn more about PHP or receive a quote, please complete the form below and we will reach out to get them the information they need. 

Any health and life licensed agent can quote and sell PHP products, even if they don't currently have business with us.

hey

A mobile app designed for you! Our member mobile app, PHP Go!, gives you access to important information and tools to make the most of your health plan on the go, in the palm of your hand. The best part – it’s FREE.

In January 2020, a public health emergency (PHE) was declared by the Secretary of the Department of Health and Human Services in response to the COVID-19 pandemic. Since that time, the PHE has been renewed several times, but it is now scheduled to expire on May 11, 2023.

Here is some information and resources to help understand how the end of the PHE may impact your health plan coverage. 

The Certificate of Coverage (also called Evidence of Coverage in Ohio) outlines a member’s rights and responsibilities as a member of PHP, and details the coverage and benefits that are purchased by an employer. The Certificate of Coverage and Evidence of Coverage provide full explanations and details for a plan, how to use services, eligibility conditions, and other services related to using a health plan with PHP. PHP members and employers may access these documents and other contract materials online, in the Benefits and Contracts section of the Member and Employer portals.

test

Whoops! Looks like we got off-course somehow.

Below are the results of our most recent Member Surveys which are compared to over 200 other commercial health plans across the United States.

Note: Percentages reflect members responding 8, 9, or 10 (on a scale of 0-10, where zero is the worst and 10 the best); or “Usually” or “Always” depending on question format.

Members of the Board of Directors with Physicians Health Plan have input in the governance and policies of our organization. Various sub-committees focus on areas such as comparing competitor and medicare fees, medical policies, pharmacy services, and additional topics based on our specific geographic area. Meet our dedicated board members pictured below.

At PHP, we care about your good health. That is why we provide you with healthcare coverage that emphasizes preventive care.

PHP can team with you to help promote employee health. Finding potential health problems before they require costly treatment and offering a variety of opportunities to help your employees adopt a healthier lifestyle are just a few of the ways we help to decrease healthcare costs.

Please be sure to verify with PHP Customer Service that these programs are included in your benefit plan before receiving services, as there are some restrictions.

We offer the following resources as part of our Health and Wellness program:

Effective April 13, 2003

 

**THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. **

At PHP, we work together as a team to help make your health insurance purchasing and use as painless as possible.

Our friendly staff is here to serve you.  If you have a question regarding plans, claims, payment, becoming a broker, credentialing or anything else, feel free to contact us.  We would be happy to help!

Not sure who to talk to?  Simply fill out our contact form, and we will get back to you as soon as possible.

Locally Managed, Community Focused

Did you know PHP is a not-for-profit health insurance company? With this, comes a true commitment to improving the quality of life in the communities we serve. A core value at PHP is community. And we put our money where our mouth is. In 2022 alone, PHP gave nearly $1 million across 150 different charitable organizations!

Our staff also contributes by giving of their time and talent. Through board and committee service, volunteer hours, and supply and collection drives, PHP employees are impacting our community for the better.

Headquartered in Indiana, PHP has a unique view of health and wellness, as well as the opportunity to engage members and families through our insurance products. Living and working in the same region as our members allows us to connect on a personal level, making sure healthcare decisions positively impact the communities we serve. More so than ever, we are uniquely qualified and prepared to advance the health and well-being of area businesses and their employees as a trusted, local resource.

PHP offers a one-of-a-kind working experience that continuously challenges all who are a part of it. We are a unique blend of top-notch professionals within a family environment with the talent to compete in the ever-changing health insurance industry and the passion to provide the highest level of customer service.

These service values extend into the community that we serve. Employees have the opportunity to volunteer and actively support a variety of organizations through company-sponsored participation in events as part of PHP's goal to be a leading corporate and philanthropic partner in the communities we serve.

Here to serve you.

We know health insurance can be complicated. If you have questions, let the insurance experts at PHP break it down for you in easy-to-understand terms. When you call PHP, you'll speak with a live, local person whose goal is to exceed your service expectations.

PHP is a local, community-based leader in providing cost-efficient and innovative healthcare solutions. Our vision and values are carried out by providing you exceptional customer service, wellness initiatives, and reliable resources.

It can be a hassle to find all the information needed for a seamless healthcare visit. Access commonly used forms, downloads, and links to help make your healthcare experience more enjoyable and efficient.

You have questions . . . we have answers.  Browse through some of our most commonly asked questions or contact us for additional information.

When it comes to health insurance, all of the terms are clear, simple, and easy-to-understand...right? Wrong! We know health insurance can be tricky but this glossary can help.

PHP offers a wide variety of products - perfect for any business.

To find out what product might be the best fit for your company, visit our Plan Finder tool.

We value our partnership with local healthcare providers and facilities, and we strive to be a valuable resource for them in all aspects. Whether it's providing outstanding service, giving quick access to the forms and tools they need, or presenting them with the latest in industry news, we are here to serve.

The healthcare industry is in the midst of a shift to value-based reimbursement, which is a dramatic change from the old model of "fee-for-service." As you make progress toward creating positive quality and cost results to ensure the best possible outcomes in your plan, keep these steps in mind:

We value our partnership with our local brokers, and we strive to be a valuable resource for them in all aspects. Whether it's providing outstanding service, giving quick access to the forms and tools they need, or presenting them with the latest in industry news, we are here to serve.

Service complaints from your clients are a thing of the past with PHP. Our member satisfaction numbers are proof that PHP takes service to another level. When your groups are with PHP, you have more time for your own business, not chasing down complaints and resolving clients issues. You can have confidence that PHP is focused on bringing you the tools and resources you need to serve your clients in the most efficient way possible.

PHP offers a variety of health insurance products for groups. Any health and life licensed agent in the State of Indiana can quote and sell PHP products.

Individual Brokerage Agreement

Corporate Brokerage Agreement

Contact one of the friendly PHP Sales Representatives listed below for more information about PHP products and services, or to receive website login information to gain access to tools and resources to help you sell.

As your Third Party Administrator (TPA), we can offer you self-funding options that allow you to use your health benefit plan dollars the way they were intended—to attract and retain the finest employees in the industry. Benefits can be customized to meet your employees’ needs while still satisfying company objectives. PHP Management Systems, Inc. will help you design your self-funded plan and handle the day-to-day planadministration that comes with it.

Choosing the right type of health plan is a crucial part of the growth and long-term success of any business. However, many employers are confused about the differences between self-funded and traditional health insurance.

With a traditional or fully-insured plan, a company pays a monthly premium. The premium is fixed and is based on the number of enrolled employees. In this case, the insurance company assumes the risk.

Self-funding is an alternative method of providing employee health care benefits in a way that offers significant opportunities to control benefit costs. With self funding, a company is responsible for paying for its own medical bills directly and a Third Party Administrator (TPA), like PHP TPA Services, performs tasks such as processing claims and issuing ID cards. Through plan design, benefit offerings, and wellness initiatives you can contain costs and offer your employees attractive health benefits. Self-funding allows cash flow to work to your advantage, rather than that of an insurance company or benefit provider.

We care about our members.  That's why we try to make it as easy as possible for you to access the forms and downloads that you need.

When you take responsibility for your health by exercising regularly, eating right, managing stress, and knowing as much as you can about general health and wellness, you can increase your lifespan and improve your quality of life overall. Our member discounts make this even easier! 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! Download a printable copy here.

Improving your quality of life is something we take very seriously. In fact, strengthening the health and wellness of our communities is one of PHP's primary objectives. We know that productivity in the workforce is directly impacted by the health and wellness of its people. Good health is critical to good business, and good health insurance is critical to good health.

Being a local, trusted resource, PHP has respect for, and is involved in, the long-term growth and success of the communities we serve. By cultivating specific data, we can tailor healthcare services to particular populations and foster initiatives focusing on improving wellness for our members and clients.

Member Survey Results

For general questions, please complete the contact form and we will be in touch as soon as possible.

Looking to contact a specific department, inquire about translation services, or file a grievance? Browse our list of helpful information below the contact form.

Thank you for your interest in PHP! We hope you'll use this page as a trusted resource for wellness tips, healthcare information, and industry news.

We publish a quarterly newsletter with health, wellness, and PHP information for our members. To view a PDF version of our most recent newsletter, click here.

If you are a media contact and need additional information, please contact:

Lea Ann Powers
Public Relations and Brand Manager
260-432-6690, ext. 554
lpowers@phpni.com

 

 

 

 

   

A new choice for Ohio businesses - PHP!

PHP is licensed to sell level-funded and large group products in the following Ohio counties: Allen, Defiance, Mercer, Paulding, VanWert, and Williams. If you are looking to make a switch in your health insurance partner, let's talk! 

Along with offering PHP TPA Services for the entire state, we are excited to help Ohio employers find solutions for their employee benefits and insurance coverage. As a regional plan based in Fort Wayne, Indiana, PHP is committed to being a community partner focused on providing access to the healthcare services and solutions that work for our local communities. Access to a network of top-notch, high quality healthcare providers and facilities is a cornerstone of a PHP plan.

 

PHP Service Area

PHP is a Fort Wayne, Indiana based employee benefits company. While we are licensed to sell our traditional full-risk products and services in 46 Northern Indiana counties and 6 Ohio counties, our self-funded health plans and administrative services are available throughout both states. Additionally, PHP's network coverage extends beyond this service area to provide comprehensive choice in doctors, hospitals, facilities, and pharmacy access for our members across the country.

Level-funded and large group products: Available to employers in Allen, Defiance, Mercer, Paulding, VanWert, and Williams counties in Ohio. 
Self-funded products and TPA services: Available throughout the entire state of Ohio. 

Have employees that work remotely outside of these areas? No problem! We offer additional network coverage to provide comprehensive access to coverage for all of your employees. 

How is PHP different? 

WE ARE A PHYSICIAN-DIRECTED, NOT-FOR-PROFIT HEALTH INSURANCE AND ADMINISTRATIVE SERVICE COMPANY

Our board of directors is comprised of regional physicians and community leaders. Together, this team helps guide our products and the delivery and direction of healthcare practices needed most by our members. Our goal is to develop long, meaningful relationships and to provide resources to improve the quality of life in our Midwest communities.

 

PHP HAS EXCEPTIONALLY HIGH CUSTOMER SATISFACTION SCORES

PHP consistently receives exceptionally high ratings for members experiences and expectations. Our customer service department answers more than 100,000 insurance-related questions per year with an average wait time of only 18 seconds. We also have a reputation for delivering our services and addressing member needs with a personal touch.

 

WE GIVE BACK TO THE COMMUNITIES WE SERVE

PHP offers grants to tax-exempt, private agencies and/or public charities throughout our service area. These grants, totaling more than $10 million dollars in the past 15 years, have helped fill voids in community needs and have offered broad social benefits to organizations with very limited resources. More than a million lives have been improved through access to medical and dental education, treatment, and medications through PHP’s charitable giving. Additionally, PHP awards academic scholarships to high school seniors pursuing careers in a health-related field. To date, nearly 100 students have received more than $150,000 to pursue post-secondary education at a college, university, or technical school.

More about the PHP Foundation

 

Are you an insurance broker or benefits advisor?

We partner with hundreds of independent insurance brokers and benefits advisor throughout the region. With online tools and resources and a responsive sales and retention team, PHP makes it easy for you to quote new business and manage your existing accounts. 

Learn more about quoting PHP for your clients

Contact the PHP Sales team

Our sales team is available with any questions you may have. Give us a call today!

PHP Options Network - Your choice for a high-value provider network

The PHP Options Network can provide cost savings while giving employees access to more than 35,000 provider locations.

  • Available for companies in 19 counties (Business must be domiciled in one of the designated counties)
  • Available for HMO plans only
  • Includes Lutheran Health System, IU Health System, Select Health Network (St. Joseph Regional Medical Center) and Goshen Health System
  • PHP Options Network does not include Parkview Health System or Community Health Alliance (Memorial Hospital, Elkhart General Hospital)
  • Includes PHCS/Multiplan for nationwide travel (emergency and urgent care situations)
  • INCLUDES EncoreCombined (across the state of Indiana; outside the plan service area; includes IU Health System and Ascension St. Vincent Hospitals)

PHP Options Network Hospitals

 

Plan Comparisons

Small Group Plans - Options Network

Large Group Plans - Options Network

LEVEL Solutions Plans - Options Network

 

Features with all PHP networks:

Emergency Coverage

All PHP members have world-wide coverage for emergency services.  An emergency is defined “Inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, requires use of the most accessible hospital available and equipped to furnish those services” according to the Department of Health and Human Services.

 

Remote Employees are Covered through EncoreCombined Network

PHP provides complete network access for employees that live outside of the plan service area through the EncoreCombined Network. 

 

Dependent Students 

To keep our student members healthy and well cared for, PHP extends in-network coverage for dependent students when they are away at college. College students may seek treatment from providers near campus as if they are in-network doctors. Simply notify PHP that a dependent college student is living outside the service area and we’ll take care of the rest.

PHP Freedom Network - Your most robust access to all regional health systems

Gives access to more than 39,000 provider locations

  • Available for companies in all 46 counties
  • HMO and POS benefit plans available
  • Allows all employees access to Parkview Health System, Lutheran Health System, IU Health System, Select Health Network (St. Joseph Regional Medical Center), Community Health Alliance (Memorial Hospital, Elkhart General Hospital), Goshen Health System
  • Includes PHCS/Multiplan for coverage nationwide (emergency and urgent care situations)
  • Includes EncoreCombined for extended network coverage throughout Indiana including IU Health Systems and Ascension St. Vincent Hospitals

PHP Freedom Network Hospitals

 

Plan Comparisons

Small Group Plans - Freedom Network

Large Group Plans - Freedom Network

LEVEL Solutions Plans - Freedom Network

 

Features with all PHP networks:

Emergency Coverage

All PHP members have world-wide coverage for emergency services.  An emergency is defined “Inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, requires use of the most accessible hospital available and equipped to furnish those services” according to the Department of Health and Human Services.

 

Remote Employees are Covered through EncoreCombined Network

PHP provides complete network access for employees that live outside of the plan service area through the EncoreCombined Network. 

 

Dependent Students 

To keep our student members healthy and well cared for, PHP extends in-network coverage for dependent students when they are away at college. College students may seek treatment from providers near campus as if they are in-network doctors. Simply notify PHP that a dependent college student is living outside the service area and we’ll take care of the rest.

New! Dual Network Plans

We now have a network solution that offers potential savings on monthly premiums, and at the same time, gives employees more control in selecting the network that is the best fit for their budget and healthcare needs.

How does a Dual Network work?

When renewing or at the time of sale, an employer selects one of our Dual Network Benefit Plans for their coverage. Once enrollment is opened to employees, the employee then has the choice of selecting either the PHP Freedom Network, with the most broad selection of providers, or the PHP Options Network, that offers a lower premium, as they complete their enrollment for coverage.

Is there a participation requirement to offer a Dual Network Plan?

Yes, these plans are available to groups with three or more enrolling employees. LEVEL Solutions plans must have five or more enrolling employees. Also, approved choices must be made available to all employees.

What counties offer access to Dual Network Plans?

Dual network plans are only available to employers in the following counties: Adams, Allen, DeKalb, Elkhart, Fulton, Huntington, Kosciusko, LaGrange, LaPorte, Marshall, Miami, Noble, Pulaski, St. Joseph, Starke, Steuben, Wabash, Wells, and Whitley.

Learn more about Dual Network Plans

 

Plan Comparisons

Small Group Plans - Dual Network

Large Group Plans - Dual Network

LEVEL Solutions Plans - Dual Network

 

Features with all PHP networks:

Emergency Coverage

All PHP members have world-wide coverage for emergency services.  An emergency is defined “Inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, requires use of the most accessible hospital available and equipped to furnish those services” according to the Department of Health and Human Services.

 

Remote Employees are Covered through EncoreCombined Network

PHP provides complete network access for employees that live outside of the plan service area through the EncoreCombined Network. 

 

Dependent Students 

To keep our student members healthy and well cared for, PHP extends in-network coverage for dependent students when they are away at college. College students may seek treatment from providers near campus as if they are in-network doctors. Simply notify PHP that a dependent college student is living outside the service area and we’ll take care of the rest.

Select the right PHP network for your employees

Finding the right network is key to helping contain costs—either by opting for a narrower network for upfront savings on premium or by verifying a network has the doctors your employees see most as to avoid higher out-of-pocket costs or denied claims. Begin by considering these factors:

  • Where is your company based and where do the majority of employees live?
  • Is cost the only factor in making this decision?
  • How important is it for employees to have access to a larger pool of doctors and facilities?

 

PHP Freedom Network

PHP Options Network

New! Dual Network Plans

 

PHP members have coverage wherever they go!

PHP includes the following provisions with ALL of our networks.

 

Emergency Coverage

All PHP members have world-wide coverage for emergency services.  An emergency is defined “Inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, requires use of the most accessible hospital available and equipped to furnish those services” according to the Department of Health and Human Services.

 

Remote Employees are Covered through EncoreCombined Network

PHP provides complete network access for employees that live outside of the plan service area through the EncoreCombined Network. 

 

Dependent Students 

To keep our student members healthy and well cared for, PHP extends in-network coverage for dependent students when they are away at college. College students may seek treatment from providers near campus as if they are in-network doctors. Simply notify PHP that a dependent college student is living outside the service area and we’ll take care of the rest.

 

Search the Directory

What is a member physician at PHP?

Member physicians not only participate in the PHP network providing services to our members, but also participate in the governance of our organization. Member physicians have a voice in developing and maintaining a local, not-for-profit health benefits company.

Member physicians govern our plan in a number of ways:

  • Election of physician directors to our board
  • Committee participation, including PHP's Medical Advisory and Credentials Committees
  • Input on strategic governance and executive selection

 

How is PHP different?

PHP is the only physician-directed, not-for-profit health benefits company in Indiana. Our board of directors is comprised of regional physicians and community leaders. Together, this team helps guide our products and the delivery and direction of healthcare practices needed most by our members. Board members generously contribute their time and talent to assist in our goal of developing long, meaningful relationships and improving the quality of life in our communities.

Learn more about what sets PHP apart

 

Annual Election Timeline

Here is the timeline for the 2024 election.  

November 2023 Nominating Committee Approves List of Nominees
March 7, 2024 Slate of Nominees Mailed to Physician Members
April 5, 2024 Nominations via Petition Due
April 8, 2024 Election Ballots and Annual Meeting Notice Mailed to Physician Members
June 5, 2024 Deadline for Receipt of Proxy Votes
June 6, 2024 PHP Annual Meeting

 

PHP's Current Board of Directors

PHP Annual Report

 

Member Physician Communication Preferences Form

Disclaimer: On November 12, 2020, HHS finalized the Transparency in Coverage Rule that requires health insurers and group health plans to display certain pricing information in machine-readable files. The files are JSON format and are not easily human readable. The files are also not meant for determining benefits, personalized costs or plan details.

PHP is NOT responsible for the end user experience as the files are very large and experience may vary from user to user based on browser, internet speeds, bandwidth, and local hardware, for example. PHP is also NOT responsible for how these files are used or interpreted by third party vendors.

 

Machine Readable Files

Post-conference Resources

Thank you to those that were able to join us on May 18! We hope you walked away with valuable information.

In case you were unable to attend, here are the presentations and live stream recording from the event.

Live stream Recording

______________________________________________________________________________________________________

Slide decks:

PHP TPA Services: Integration, Platform Updates, and Vendor Partnerships

Lisa Gibson, President, PHP TPA Services

 

Cost Management Services: Care Navigation, Physician-led Medical Bill Review, Open Access Medical Plans

Scott Fuqua, VP - New Business Development, AMPS

 

Unmasking the Pharmacy Benefit Manager: Visibility and Understanding of your Pharmacy Arrangement

Anthony Masotto, VP of Pharmacy, Drexi

 

Self-Funded Risk Management: A Stop Loss Perspective

Steve Butz, Executive Vice President, Certus Management Group

 

Legal Update: Top Ten Benefit Pitfalls

Michael Nader, Partner, Barnes & Thornburg

Guidance on Appealing Payment Adjustments

If Group Code/Adjustment Reason Code is OA-223   The claim was processed according to the qualifying payment amount (QPA), as defined by the No Surprises Act Regulations. The methodology for each QPA was determined in compliance with the Regulations. If the out-of-network provider or facility wishes to initiate a 30-day open negotiation period, they may contact ClearHealth via the secure portal https://provider.clearhs.com or by calling (866) 722-3773.

If Group Code/Adjustment Reason Code is PR-45   The claim was processed according to the Maximum Allowed Amount for the service or procedure based on the member's plan benefit.  The member may be responsible for amounts other than deductible, copays, and coinsurance. Providers with questions related to the Maximum Allowed Amount may contact ClearHealth at (888) 736-1504. For any other questions related to benefits or eligibility, please call PHP at 800-982-6257, ext. 11.

Join us for this educational event!

PHP: A New Health Insurance Option in Ohio

PHP and Gibson are hosting a quick discussion around a new health insurance option available to employers in Ohio! PHP gained licensing in Ohio in late 2023 and has new plan options available for your group coverage for your employees. 

 

How is PHP different from other insurance carriers? 

PHP is a physician-directed, not-for-profit health insurance and administrative services company. Our goal is to develop long, meaningful relationships with employers to identify cost-effective solutions for providing employee health benefits. We offer a spectrum of products to grow and adapt with your business needs, and to manage costs and find efficiency with your plan. 

PHP consistently receives high ratings for member experience and expections. Our local customer service department answers more than 100,000 insurance-related questions each year with an average wait time of only 18 seconds. With quality, easy-to-use coverage, PHP is an attractive addition to your benefits package helping you recruit and retain top talent for your team. 

 

Please join us for this webinar to learn more:

Thursday, March 28th

10 am – 11am

 

Click here to register!

Save on your group health insurance: The PHP Chamber Discount Plan for employers with 5–50 enrolled employees

 

PHP is pleased to offer a member-only discount health insurance program that can save employers up to 30% over ACA plans. Providing affordable group health benefits is one of the top challenges facing employers today—and we have a solution.  Together, we want to make our communities healthy!

This plan is similar to traditional medical plans, but with a few key differences to offer lower rates and more financial flexibility.  As a level-funded health plan, employers can save through certain tax savings over ACA plans.

Participating Organizations:

 

Keep checking back as we add more organizations to the program!

 

The PHP Chamber Discount Plan offers:

  • SAVINGS: Up to 30% over traditional, ACA-rated plans.
    • Chamber members receive an additional 5% discount.
  • NETWORK FLEXIBILITY: Broad and narrow network options.
  • DATA: More access to plan data and detailed reporting information.
  • VALUE +: Added discounts on products and services available in our region.
  • WELLNESS INITIATIVES: PHP offers custom, on-site wellness solutions to keep your employees healthy, on-the-job, and help contain premium increases.

Call your benefits advisor today and ask about the PHP Chamber Discount Plan for your business. Or contact PHP at: sales@phpni.com; 260-432-6690, ext.840.

 

PHP Chamber Discount Plan

Download PHP Go! Today

To get started, search for PHP Go! from the App Store or Google Play. Once downloaded, log in using your PHP Member Account credentials. If you do not have a Member Account yet, select “First Time User?” once the app is open to begin.

Download the PHP Go! Flyer

Here are some features of the PHP Go! app:

 

 

 

 

   Member ID Card
   Instant access to view or download your Member ID card, on your mobile device.
 

 

 

 

 

 

 

 

View Your Claims  
View your medical claims in the mobile app, check claim status, or download EOBs for health-related expenses. 

 

 

 

 

 

 

   Preventive Services
   Find services and screenings, covered at no cost sharing to you.

 

 

 

 

 

 

 

Treatment Cost Estimator  
Estimate and compare costs for common services with various healthcare providers. 

 

 

 

 

 

 

 

Price a Medication  
Compare your medication between locations and find the lowest cost before heading to the pharmacy.

 

 

 

 

 

 

Find Care  
Find nearby physicians or facilities that are in your network.  

 

 

 

 

 

   

   Benefits and Year-to-Date Totals
   View benefit information and monitor your year-to-date totals tracking deductibles and out-of-pocket expenses.

 

 

 

 

 

   

 

 

   Wellness
   Access our telehealth services, nurseline, and more.

 

 

 

 

 

 

 

Contact  
Reach out to our friendly, local customer service team, directly from the mobile app. 

 

 

 

 

Welcome Lake and Porter Counties!

We are excited to serve more of our Indiana neighbors as we expand to the most northwest corner of our state. For over 35 years, Physicians Health Plan of Northern Indiana (PHP) has given businesses a local, non-profit alternative to large, national health plans. Governed by area physicians and business leaders, PHP is a part of the communities we serve.

Headquartered in Fort Wayne, PHP partners with the local medical and business communities to provide employee benefits and health plan solutions for all sizes of companies. Access to a network of top-notch, high quality healthcare providers and facilities is a cornerstone of a PHP plan.

Consider joining our network to give Lake and Porter county residents more choice to meet their healthcare needs.

Credentialing Process Overview

Who is PHP?

FAQ

 

Complete and return a credentialing form to get started!

Provider Credentialing Form

Healthcare Facility Credentialing Form

Keeping you covered while you're away at school

Keeping our members covered with access to medical care is a priority. If you are attending a college or university, simply let us know where you will be living to avoid issues with your coverage. Complete the short form below and you are all set.

Remember, preventive services are important to maintaining your health! Don't put off various health screenings while you are away at school.  

What does the end of the PHE mean for you and your health coverage?

Many coverage provisions were broadened, relaxed, or impacted in other ways during the COVID-19 pandemic to provide greater access to certain services. With a return to pre-pandemic healthcare practices, it’s important for healthcare consumers to stay informed about regulations and policies that may impact their access to and coverage of services. As always, it is always best to understand and/or verify coverage and benefit limitations BEFORE receiving services.

Tolling Periods:

The COVID-19 National Emergency (different from the Public Health Emergency) included a regulatory tolling period for individuals to report or file for HIPAA special enrollments, COBRA events, and claims/appeals. A tolling period is, essentially, a period of time in which days or time is not counted, meaning time limits for these activities or events were extended or relaxed during the National Emergency. The National Emergency ended on April 10, 2023; however, the Department of Labor has informally determined that the tolling periods will continue up to, and including, July 10, 2023. After that time, these provisions and qualifications revert back to what they were pre-COVID.”

COVID-19 Vaccines:

Coverage for the COVID-19 vaccine will move under your preventive benefit. This means that you would have zero out-of-pocket costs for the COVID vaccine, when administered by a provider in your network. If the vaccine was received at an out-of-network location, out-of-network charges would apply. 

Testing and Treatment:

Testing and treatment for COVID-19 will be covered under the terms of your benefit plan. You will now have to pay your plan’s cost share for these services, and you will also have to see a provider in your network for these services to be paid at in-network rates.

Telehealth Coverage: 

During the pandemic, PHP waived fees related to using our telehealth service, Parkview OnDemand. We will continue to offer Parkview OnDemand to members at no cost share for members. 

 

Here are answers to the most common questions that we receive.  If your question is not answered here, please contact PHP Customer Service at (260) 432-6690, or toll-free at 1-800-982-6257.

Customer Service:

260-432-6690, ext. 11
800-982-6257, ext. 11
FAX:  260-432-0493

Medical Management:

Prior authorization:

260-432-6690, ext. 12
800-982-6257, ext. 12
FAX:  260-436-4809

Claims Information:

HMO Submit claims to:

Physicians Health Plan 
P.O. Box 2359
Fort Wayne, IN 46801-2359

Provider Network Services:

For questions about participating with us, updating participation status or practice information, fee schedules, staff in-services, billing, and contracting efforts, contact:

Dawn Dager
Provider Contracting Supervisor
260-421-4304
ddager@phpni.com

Toni Simmons
Credentialing Coordinator
260-421-4319
tsimmons@phpni.com

Susan Werner
Director Provider Implementation & Services
260-421-4528
swerner@phpni.com

Pharmacy:

Precertification/Questions: 260-432-6690, ext. 339

Dental:

Precertification/Questions: 260-432-6690, ext. 12

Understanding the Member ID Card

Below is a sample of the front and back of the PHP ID card:

PHP has an open access network.  This means that members are free to see any provider in the network without having to jump through a bunch of hoops.

Depending upon the product purchased, members may have different PHP Networks. Below is a brief description of PHP Networks.

Search the Provider Directory

PHP Freedom Network

Gives access to more than 39,000 provider locations

  • Available for companies in 46 Indiana and 6 Ohio counties
  • HMO and POS benefit plans available
  • Allows all employees access to Parkview Health System, Lutheran Health System, IU Health System, Select Health Network (St. Joseph Regional Medical Center), Community Health Alliance (Memorial Hospital, Elkhart General Hospital), Goshen Health System, and more.
  • Includes PHCS/Multiplan for coverage nationwide (emergency and urgent care situations)
  • Includes EncoreCombined for extended network coverage throughout Indiana including Ascension St. Vincent Hospitals

PHP Options Network

PHP Options Network can provide cost savings while giving employees access to more than 35,000 provider locations.

  • Available for companies in 19 Indiana counties (Business must be domiciled in one of the designated counties)
  • Available for HMO plans only
  • Includes Lutheran Health System, IU Health System, Select Health Network (St. Joseph Regional Medical Center) and Goshen Health System
  • Options does not include Parkview Health System or Community Health Alliance (Memorial Hospital, Elkhart General Hospital)
  • Includes PHCS/Multiplan for nationwide travel (emergency and urgent care situations)
  • Includes EncoreCombined (across the state of Indiana; outside the plan service area)

 

Network FAQs

Welcome to PHP!

We would like to take this opportunity to welcome you and your staff to our participating provider network.

PHP offers many online tools to assist you. At phpni.com, you can access the following information:

  • Member Eligibility
  • Clinical Policies
  • Benefits
  • Provider Directory
  • Precertification Requirements
  • Drug Formulary

PHP has an outstanding service team available to you. Contact our knowledgeable Customer Service representatives with any questions you may have at 1-800-982-6257, ext. 11. If you would like to schedule an onsite training or in-service, a member of our Provider Services team is available to you. Please feel free to contact them at 260-421-4304 or 260-421-4383.

Thank you for your participation in the PHP network!

  • Founded in 1983
  • Headquartered in Fort Wayne, Indiana
  • Not-for-profit, tax exempt and physician sponsored
  • Experienced staff of approximately 160 employees
  • Open access network; members free to see any physician in the network
  • Committed to our community and corporate giving
  • First dollar coverage for many preventive services with all plan options
  • Around the clock resources online at www.phpni.com, MyNurse 24/7 and with Parkview OnDemand

Our Products and Services

HMO Plans

Our fully-insured HMO plans allow coverage for medical services available through our comprehensive network of providers. All plans include first-dollar coverage for many preventive services.

Point-of-Service Plans

Our products offer the ability to purchase Point-of-Service benefits, allowing members to use providers outside of the PHP network.

HSA Compatible High Deductible Plans

Our HDHPs are a cost-effective way to obtain coverage and can also be combined with an HSA from the bank of your choice.

Additional Products:

  • Dental and Vision  
  • Life & Disability  
  • TPA Services including:
    • Employer-sponsored health plans  - services for mid to large employers wanting to self-fund their health plan.
    • LEVEL Solutions  - a self-funded product with stop-loss coverage for groups with 5-100 enrolled subscribers.
    • Flexible Spending Accounts and Health Reimbursement Arrangements (HRAs) 

Download our Printable Overview

We have gathered many of the forms that you may need and placed them in one location.  Please follow the submission instructions on the specific form you are completing.  For general questions, please contact PHP Customer Service at (260) 432-6690, or toll-free at 1-800-982-6257.

Here’s an archive of the most recent Provider Update newsletters. The Provider Update includes various PHP information, coding reminders and tips, and policy updates.

 

2022

2019

2018

2017

Get all the answers to your pharmacy-related questions in one convenient location.

To assist with receiving the highest quality of care at the most affordable price, our pharmacy benefit program has been designed to include five levels of prescription drug coverage. These five levels are described below.

Why is it important to understand pharmacy benefits?

Getting the most out of an individual's healthcare insurance coverage is important. Understanding a pharmacy benefit and how it works can save money on the cost of prescriptions and thus maximize the benefit.

It is important for patients to work with their doctor on how best to maintain good health and how to successfully manage any existing health conditions.

When medicines are needed to treat a health condition, patients should understand how to get the most effective drug treatment while controlling the cost of prescriptions.

What is a tiered copayment pharmacy benefit and how does it work?

A tiered copayment benefit means there are several possible copayment levels. A member’s copayment is based on the prescription drug being purchased. For example, the first tier represents a preferred generic drug that has the lowest copayment.

Traditional Drugs

TIER 1 Preferred Generic

Covered drugs that are no longer protected by a drug company patent allowing other drug companies to manufacture equivalent versions of the same drug at a reduced cost.

TIER 2 Non-Preferred Generic

Similar to Tier 1 covered drugs, but available with a higher copayment.

TIER 3 Brand Formulary

A list of brand-name drugs that PHP participating network doctors are encouraged to prescribe, when appropriate, for treatment of a medical condition.

TIER 4 Brand Non-Formulary

Covered drugs that are not included in the formulary listing. You may obtain nonformulary brand-name drugs with a higher pharmacy copayment.

Speciality Drugs

TIER 1 Preferred Speciality Drugs*

These medications can be injectables or orals that are extremely expensive, must be filled at a speciality pharmacy, and may need special instructions and handling.

TIER 2 Speciality Drugs

These medications can be injectables or orals that are extremely expensive, must be filled at a speciality pharmacy, and may need special instructions and handling.

*This tier is newly added, and reserved for future use. There are currently no drugs in this tier. We anticipate adding drugs to this tier in July 2023.

Maximize the Pharmacy Benefit

Sometimes it’s possible to swap a prescription for an over-the-counter drug, a great way to save dollars. Staying on top of need-to-know prescription information can also save money. But it can also save a life by preventing medical mix-ups. Tips for avoiding serious side effects and overdosing are included with prescription drugs.

Our drug formulary was developed by the PHP Pharmacy and Therapeutics Committee, which is comprised of physicians from various medical specialties.  The committee reviews medications in all therapeutic categories based on safety, effectiveness, and cost.

We have several resources to help you understand and use our drug formulary.  If you would like to request a specific drug be added to the formulary, complete and return the request form under Pharmacy Forms.

Electronic claim and payment submission provide administrative simplification and faster payment times.  PHP supports HIPAA standard transaction sets through a variety of clearinghouses and direct submission relationships.

With each check you will receive a Provider Remittance Advice (PRA), which is a statement explaining the services that are being paid.  Similarly, patients receive an Explanation of Benefits (EOB) that defines what was paid by PHP and what is their payment responsibility to the provider.

Download a sample PRA

Online Provider Remittance Look Up

For your reference, here is a listing of the fields found on the PRA statement and a description of what each field means.

Field Name

Description

Procedure Code

CPT code or revenue code for the service provided.

Date of Service

Date or Date Range for the service provided.

Quantity

Number of Units requested for the Procedure Code.

Billed Amount

Amount requested by the Provider.

Network Amount

Amount provided by network repricer.

Provider Responsibility

The amount the provider must write off in accordance with their provider contract as a result of discounts or fee schedule arrangements. The provider may not bill the member for these amounts.

Withhold

The amount retained by PHP as a “Physicians Contingency Reserve” per the Provider’s Contract.

COB

The amount paid by another insurance carrier.

Deductible

The amount you may collect that applies to the member’s deductible per the Member Contract.

Copay / Coinsurance

The amount you may collect that applies to the member’s copay or coinsurance liability per the Member’s Contract.

Patient Responsibility

The amount you may collect from the member, in addition to the member’s liability for deductible, copay, and coinsurance.

Adj. Code

The Adjustment Code for that claim line. The description of the code is printed at the end of the Provider Remittance Advice.

PHP requires prior authorization for certain services that are provided to our members, including off-plan referrals.  Please familiarize yourself with these services and requirements.  Forms for submitting prior authorization requests can be found under the Forms section.

Please reference the table below under "How to Use Modifiers Correctly" for direction on using Modifiers. For a complete explanation of Modifier usage, consult the CPT manual. 

Proper coding ensures prompt and timely claims payment.  Please refer to these guidelines to make your claims submission and service payment a seamless process.

Find all the resources that you need in one convenient place. That's PHP Easy!

Below is a list of various documents that provide guidance and outline our administrative procedures for different situations, including provider disputes and professional review. Select a file for more information:

PHP TPA Services Members

Find a Participating PHP Doctor or Facility

First select a network then enter category, address, or keyword to get started. Please refer to your member ID Card or call Customer Service if you need assistance verifying your network name. Searching the correct network can help you avoid higher out-of-network costs.

Already a member? Log-in for personalized search results based upon your plan.

Pro-Claim Members

Find a Participating PHP Doctor or Facility

First select a network then enter category, address, or keyword to get started. Please refer to your member ID Card or call Customer Service if you need assistance verifying your network name. Searching the correct network can help you avoid higher out-of-network costs.

Already a member? Log-in for personalized search results based upon your plan.

Pro-Claim Members

Find a Participating PHP Doctor or Facility

First select a network then enter category, address, or keyword to get started. Please refer to your member ID Card or call Customer Service if you need assistance verifying your network name. Searching the correct network can help you avoid higher out-of-network costs.

Already a member? Log-in for personalized search results based upon your plan.

First step accomplished – you’ve reached your dashboard!  Below you’ll find some new employee training materials to give you an overview about working at PHP.  Welcome to the team!

Please contact your Account Manager at 1-800-982-6257 for more information or login to your account for a copy of your Certificate of Coverage.

Sample Certificate of Coverage - Indiana

 

Sample Certificate of Coverage (or Evidence of Coverage) - Ohio

We can't seem to find your Plan Finder results at the moment, but we're doing everything we can to track them down. In the meantime, feel free to contact a PHP customer support representative to move forward with your health insurance search.

HMO Plans

2018

Small Group                                                                                                                                                                                                                                                                                                                                  Sample 2018 HMO Plans - Prime Network 
Sample 2018 HMO Plans - Options Network  
Sample 2018 HMO Plans - Classic Network  
Sample 2018 HMO Certificate of Coverage

Large Group                                                                                                                                                                                                                                                                                                                                       Sample 2018 HMO Plans - Prime Network only  
Sample 2018 HMO Certificate of Coverage

2017

Small Group
Sample 2017 HMO Plans - Prime Network
Sample 2017 HMO Plans - Options Network
Sample 2017 HMO Certificate of Coverage 

Large Group
Sample 2017 HMO Plans - Prime Network
Sample 2017 HMO Plans - Options Network
Sample 2017 HMO Certificate of Coverage

Point of Service Plans

2018

Small Group                                                                                                                                                                                                                                                                                                                                  Sample 2018 POS Plans - Prime Network    
Sample 2018 POS Plans - Classic Network   
Sample 2018 POS Certificate of Coverage

Large Group 
Sample 2018 POS Plans - Prime Network only

Sample 2018 POS Certificate of Coverage

2017

Small Group
Sample 2017 POS Plans - Prime Network only
Sample 2017 POS Certificate of Coverage

Large Group 
Sample 2017 POS Plans - Prime Network only
Sample 2017 POS Certificate of Coverage

High Deductible Plans

2018

Small Group                                                                                                                                                                                                                                                                                                                                                                                                                                                                Sample 2018 HDHP HMO Plans - Prime Network   
Sample 2018 HDHP HMO Plans - Options Network   
Sample 2018 HDHP HMO Plans - Classic Network   
Sample 2018 HDHP POS Plans - Prime Network   
Sample 2018 HDHP POS Plans - Classic Network    
Sample 2018 HDHP HMO Certificate of Coverage  
Sample 2018 HDHP POS Certificate of Coverage

Large Group                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sample 2018 HDHP HMO Plans - Prime Network only    
Sample 2018 HDHP POS Plans - Prime Network only   
Sample 2018 HDHP HMO Certificate of Coverage  
Sample 2018 HDHP POS Certificate of Coverage

2017

Small Group                                                                                                                                                                                                                                                                                               Sample 2017 HDHP HMO Plans - Prime Network 
Sample 2017 HDHP HMO Plans - Options Network 
Sample 2017 HDHP POS Plans - Prime Network only 
Sample 2017 HDHP HMO Certificate of Coverage 
Sample 2017 HDHP POS Certificate of Coverage

Large Group                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Sample 2017 HDHP HMO Plans - Prime Network
Sample 2017 HDHP HMO Plans - Options Network
Sample 2017 HDHP POS Plans - Prime Network only 
Sample 2017 HDHP HMO Certificate of Coverage 
Sample 2017 HDHP POS Certificate of Coverage

LEVEL Solutions

2017-18

HMO Plans
POS Plans
High Deductible Plans

 2023 Survey Results

Key Questions PHP Results Other Health Plans' Results
Ease of getting care needed 84% 81%
Ability to get care quickly 85% 80%
How well do your doctors communicate with you 97% 95%
Customer service experience 90% 87%
Claims handled quickly and accurately 92% 87%
Rating of healthcare 76% 75%
Rating of your personal doctor 86% 85%

 

2022 Survey Results

Key Questions
PHP Results Other Health Plans' Results
Ease of getting care needed
88% 84%
Ability to get care quickly
87% 83%
How well do your doctors communicate with you
97% 95%

Customer service experience

91%

88%
Claims handled quickly and accurately 96% 88%
Rating of healthcare 79% 81%
Rating of your personal doctor 88% 87%

 

2021 Survey Results

Key Questions
PHP Results Other Health Plans' Results
Ease of getting care needed
88% 86%
Ability to get care quickly
87% 85%
How well do your doctors communicate with you
94% 95%

Customer service experience

91%

90%
Claims handled quickly and accurately 93% 90%
Rating of healthcare 78% 79%
Rating of your personal doctor 85% 87%

We can help!

In conjunction with any well care benefits an employer may select, PHP sends out various educational and informational pieces and also works with employers who wish to institute employee health education programs and various wellness initiatives. These efforts include:

What is the purpose of this Notice of Privacy Practices?

PHP is required by federal law to provide you with this Notice of Privacy Practices (Notice), describing how we use and disclose your protected health information (PHI), and your rights regarding your PHI. This law, referred to as the Privacy Rule, is a provision of the Health Insurance Portability and Accountability Act of 1996.

What is protected health information (PHI)?

PHI is information about a member’s or an applicant’s health or healthcare services that we create or receive, and maintain, which can be identified as pertaining to that person. PHI includes electronic PHI.

Is my PHI kept private?

Yes. We understand the seriousness and sensitivity of privacy issues and recognize the importance of confidentiality. We are also required by the Privacy Rule to keep your PHI private. We strongly believe in protecting the confidentiality and security of your information, and follow strict policies to protect your information. We have a Privacy Officer who is responsible for seeing that your PHI is used and disclosed appropriately.

How does Physicians Health Plan use and disclose my PHI?

We use PHI to operate our day-to-day business. This business includes processes related to payment for healthcare treatment and other healthcare services, and the routine operation of our business. We may use and disclose PHI, without individual authorization, for these purposes.

We may use or disclose PHI for payment activities, including: adjudication of claims, coordination of benefits, utilization review, pre-certification review, medical necessity review, coordination of care, collection of payments, collection of reinsurance payments, determination of eligibility, subrogation of claims, risk adjusting, reimbursement, claims management, and determination of cost sharing. There are many different reasons why we use PHI for payment. For example, our claims department uses PHI when we pay a provider or facility for the services or treatment you received. We may also ask for additional PHI from your provider about your treatment before we consider the claim for payment. We may disclose PHI to your provider as necessary to help coordinate your services.

We may use and disclose PHI for healthcare business operations and legal processes, including: customer service, resolution of grievances and appeals, fraud and abuse detection and prevention, general administrative activities, business management, auditing, medical review, disease management, case management, treatment alternatives, protocol development, underwriting and premium rating, enrollment, provider credentialing, quality assessment and improvement activities, review of healthcare performance, outcome evaluations, accreditation purposes, certification, training, regulatory compliance, legal services, licensing, and law enforcement. We use PHI as part of these processes to manage the health plan that you currently use. For example, we may use PHI for monitoring quality and improving healthcare services, providing disease management programs, and reducing health care costs. We may contact you at times to provide health education materials or health-related benefit information. We may also use PHI for underwriting purposes to determine the premium to charge for your benefit coverage. We will not use genetic PHI for purposes of underwriting.

We may share your PHI with other businesses who help us operate our business. We will not share your PHI with these outside businesses unless they agree to protect it. If you are covered under an Employer Group Health Plan, we may also disclose PHI to a plan administrator at your place of employment, for plan administration purposes and to administer the terms of our contract with your Employer. Most employers that choose to request and receive PHI must comply with the Privacy Rule and tell you that they receive PHI from us.

We may also use and disclose PHI without your authorization when you are unable to make a health care decision for yourself, or are unable to provide a written authorization. For example, if you are unconscious, or very ill, or otherwise unable to provide authorization, we may make a professional judgment and disclose PHI in this situation to an apparent caretaker, such as a family member or friend who is involved in your care.

In situations other than payment and operational functions as listed above, we will ask for your authorization before we use or disclose your PHI. If you give us your written authorization and decide later you do not want us to use or disclose this information any longer, you may revoke your authorization in writing to us at any time. Your revocation will not apply to uses and disclosures of your PHI already made before you revoked an authorization.

We will not sell any PHI, or use PHI for marketing or fundraising purposes.

Does Physicians Health Plan have any legal duties that could involve using or disclosing my PHI?

We are required to share your information in other ways- usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these proposes. For more information see: https://www.hhs.gov/hipaa/index.html. We must disclose PHI:

  • when required to do so by federal or state law (for example, abuse, neglect or domestic violence);
  • when required to do so by rules and laws applicable to civil or criminal lawsuits;
  • to prevent a serious threat to your health or the health and safety of the public or another person;
  • if a government agency is investigating or inspecting a health care provider or Physicians Health Plan; and/or
  • to the Department of Health and Human Services, if asked, so it can make sure we are complying with this Privacy Rule.

What are my rights under the Privacy Rule?

The following items explain your rights.

  • Privacy Notice. You have a right to receive a copy of this Notice by mail or electronically, at your request. This Notice is also on our website at www.phpni.com.
  • Personal Representatives. You have the right to choose someone to represent you. Your personal representative would have the same rights as you do. Your personal representative could make requests and authorizations on your behalf.
  • Restrictions. You have the right to request restrictions on how we use or disclose your PHI. For example, you may choose to request that we not share your PHI with family members who may be involved in your care, or that we limit the information we provide to such family member. PHP is not required to agree to the restriction.
  • Confidential Communication. You have the right to confidential communication. If you are in a situation where your own PHI being directed to your listed home address could place you in danger, you may receive communications at an alternate address. Your request must be in writing, specifying that you could be in danger if your health information is directed to your listed home address. Your written request should clearly state where or how you prefer to receive communication.
  • Access. You have the right to access your own PHI. You may view or receive copies of your PHI that PHP maintains in a designated record set for the uses listed in this Notice. Copies of psychotherapy notes and certain PHI that we may prepare for use in a civil, criminal or administrative action or proceeding will not be released. We will charge you a fee that is allowable by applicable law, based on the cost of copying and postage. If we maintain electronic records containing your health information, when and if we are required by law, you will have the right to request that we send a copy of your protected health information in an electronic format to you or a third party that you identify. We may charge a reasonable fee for sending the electronic copy of your health information.
  • Accounting of Disclosures. You have the right to an accounting of disclosures of your PHI. We will keep a log of any non-routine disclosures of your PHI. This information will be maintained for 6 years after any applicable disclosure. We will give you one list of disclosures in a 12-month period for free. If you ask for another list in the same 12-month period, we will tell you in writing that there will be a reasonable charge to prepare your list. You can let us know in writing whether you still want us to give you the information requested or whether you want to change your request. Our list will not include disclosures that we made:
  1. for the payment and business operations purposes defined in this Notice
  2. directly to you, to your personal representative, or under your written authorization
  3.  for national security purposes 4. to correctional or law enforcement personnel
  • Amendment. You have the right to correct your PHI or add missing information if you think there is a mistake regarding your PHI. You must provide us with the reason the information we have is incorrect. This information must be provided to us in writing. If we did not create the record, or if we believe the record to be accurate, we may decline to change the record, but we will add your request and the information you provide to your record so that it becomes a part of your record.
  • Notice. We are required to notify you of a breach involving your unsecured PHI.

All requests to us must be in writing, except a request for a copy of this Notice. You can send your written request to the address listed at the bottom of this Notice, Attention: Privacy Officer, or send an email to custsvc@phpni.com. We will respond to you within 30 days after we receive your written request. The Privacy Rule allows us 60 days to consider and respond to you when you ask us to correct your PHI or request a list of PHI disclosures. We will tell you if we need up to an additional 30 days to consider your request when we reply to you in writing.

We will always give serious consideration to your requests. In certain situations, we may deny your request if we cannot reasonably comply. If we deny your request, we will tell you the reason in writing. Our denial will also explain that in certain situations you may have the right to have the denial reviewed.

Will Physicians Health Plan follow the terms of this Notice?

Yes. We are required by the Privacy Rule to follow the terms of this Notice. This Notice will remain in effect until it is replaced or modified. PHP will revise and distribute within 60 days this notice whenever there is a material change.

Will Physicians Health Plan change its privacy practices or the information in this Notice?

We reserve the right to change the information in this Notice and to make the changes effective for all PHI that we maintain. The revised Notice will be on our website at www.phpni.com. We will send you a copy of the new Notice upon request.

How do I file a complaint about Physicians Health Plan’s privacy practices?

If you believe that your privacy rights have been violated, you can contact our Privacy Officer or the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint about our privacy practices. We want to know if you have a concern about your privacy at PHP. Please contact us with any concerns or questions.

You may contact our Privacy Officer by:

  1. Sending your written complaint to PHP Customer Service Department, Attn: Privacy Officer, 1700 Magnavox Way, Suite 201, Fort Wayne, IN 46804
  2. Calling a Customer Service representative at 260-432-6690,ext. 11 or toll-free at 1-800-982-6257
  3. Sending an email to custsvc@phpni.com.

You may also contact the Secretary of the Department of Health and Human Services. We will give you their address upon request.

Who do I call if I have any questions about the information in this Notice?

If you need additional information or have questions about anything mentioned in this Notice, please contact our Customer Service Department at 260-432-6690,ext. 11, toll-free at 1-800-982-6257, or sending an email to custsvc@phpni.com.

Policy Statement

Physicians Health Plan (PHP) is committed to the prevention of healthcare fraud. Fraud or abuse of healthcare benefit payment results in higher healthcare costs and higher insurance premiums for everyone. Healthcare fraud is a crime. It is the policy of PHP to monitor for evidence of fraud and to investigate allegations of fraud or abuse of healthcare benefit coverage.

Examples of Healthcare Fraud

Healthcare fraud is committed when someone intentionally submits false or misleading information to obtain payment for healthcare services. Examples include:

  • A healthcare provider or member submitting a claim for an item or service more expensive then the item or service provided.
  • A healthcare provider or member submitting a claim for services not rendered, or not necessary, or provided to a person other than the covered member.
  • One individual using another individual's insurance coverage information to receive services. (One person posing as another person.)
  • A health plan member enrolling an individual who is ineligible for coverage under the plan. 

Preventing Healthcare Fraud 

How You Can Avoid, Identify, and Prevent Healthcare Fraud

  • Ask questions about the services you receive.
  • Fill out, sign, and date one claim form at a time; never sign a blank form.
  • Question advertisements or promotions by providers that offer free tests, treatment or services, especially if you are required to provide insurance information.
  • In general, be careful about disclosing your insurance information. Protect your identification card. It represents your benefits.
  • Examine your medical bills and compare your bills to your records and your PHP Explanation of Benefits (EOB).
  • Report suspected fraud to a PHP representative. 

Reporting Possible Healthcare Fraud 

Each of us can help control healthcare costs by being alert for signs of possible fraud. Please notify PHP if you suspect that your information has been utilized in an attempt to fraudulently obtain payment or services.

  • You may contact your customer service representative at (260) 432-6690, ext. 11; (800) 982-6257, ext. 11; or (260) 459-2600 for the hearing impaired.
  • You may contact your customer service representative via the PHP Web site at www.phpni.com, or by email at custsvc@phpni.com.

The HIPAA portability provision, as the name implies, is designed to improve the portability of health coverage for people who are changing jobs and to make it easier to add family members to an employees’ coverage. HIPAA portability applies to group health plans and issuers of group health plans. So both the employer and the insurer are obligated to comply.

Certificate of Creditable Coverage

Part of the HIPAA portability provision is issuing a Certificate of Creditable Coverage (COCC). The COCC must indicate the date that any waiting period began and the dates that coverage under the plan began and ended. On the back of the COCC is educational information explaining HIPAA rights. PHP issues a COCC:

  • when regular coverage is lost; 
  • when COBRA coverage is lost; 
  • when a COCC is requested by a member while still active; and
  • within two years after losing coverage.

After termination of coverage, if a member is moving to another health plan that has a pre-existing condition exclusion (PCE), the timeframe reflected on the COCC can be used to reduce the PCE period by one day for every day of creditable coverage listed on the COCC.

Special Enrollment

HIPAA requires a group health plan to provide a special enrollment opportunity to employees and their dependents under certain circumstances. A few examples of these circumstances are listed below. 

If the employee and or dependent did not enroll in the plan because they had other coverage and requested special enrollment within 30 days, they would be eligible for special enrollment when:

  • they lost coverage because they lost eligibility;
  • the employer contributions for the coverage ceased;
  • the COBRA period of 18, 29, or 36 months was exhausted; or
  • an employee acquires a new spouse or dependent by marriage, adoption, placement for adoption or birth. The special enrollment right applies to the employee, the employee’s spouse and the newly acquired dependent.

If coverage is gained or lost under a Medicaid or CHIP Program, the special enrollment period is 60 days.

Department of Labor resources for more HIPAA Portability information:

What is HIPAA?

PHP has always recognized the importance of privacy and security of member health information.

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). This Act established a number of significant regulatory requirements for health plans. Title II of HIPAA deals with, among other issues, the creation of standards for the collection, use, disclosure, and electronic transmission of healthcare information by healthcare providers, health plans, and healthcare clearing houses ("covered entities"). Those provisions are referred to as the "administrative simplification" requirements of HIPAA.

Administrative Simplification Requirements of HIPAA

The major requirements of administrative simplification are:

PRIVACY OF HEALTH INFORMATION

The standards of health information privacy govern the use and disclosure of individually identifiable health information by health plans, healthcare providers, and healthcare clearinghouses and their business associates.

SECURITY OF HEALTH INFORMATION

The security rule provides safeguards for data storage, protection of information transmission systems, and the establishment of chain-of-trust agreements between covered entireties and their business partners.

ELECTRONIC TRANSACTIONS STANDARDS & IDENTIFIERS

This rule establishes standards for eight healthcare transactions (healthcare claims or equivalent encounter information; eligibility for health plan; referral certification and authorization; healthcare claims status; enrollment and disenrollment in a health plan; healthcare payment and remittance advice; health plan premium payments; and coordination of benefits) and designates the code sets used for those transactions.

The identifier rules are intended to establish unique identifiers for employers and providers that will be used in electronic healthcare transactions.

DISCLAIMER: The subject matter covered has been provided with the understanding that PHP is not engaged in rendering legal or other professional services. If legal advice or other expert assistance regarding compliance with HIPAA laws and regulations is required, the service of a competent professional person should be sought. The user of this HIPAA information shall assume total responsibility and risk of its use. In no event shall PHP be liable for any damages whatsoever, including but not limited to special, direct, indirect, consequential, or incidental damages, or damages for lost profits, loss of revenue, or loss of use, arising out of or related to the information provided.

 

June 8, 2016

PHP is committed to accessibility, diversity and inclusion. We believe all of our members and visitors should be able to easily access and use our web site portals and digital offerings.

If you're using assistive technologies to access our site, our mission is to deliver the experience you expect. We want PHP to be your preferred health insurance provider in all channels by fulfilling our brand promise of "PHP Easy."

 

How we are accomplishing these goals:

We've set high standards for our web accessibility and are planning a complete web redesign by the close of 2016. PHP is committed to ensuring that its website is accessible to people with disabilities. All the pages on our website will meet W3C WAI's Web Content Accessibility Guidelines 2.0 conformance when our new site is launched.

Questions about our position and/or policy should be directed toward: accessibility@phpni.com

Please choose from the list of policies below to learn more:

The PHP Foundation

The PHP Foundation is dedicated to building healthier communities by addressing the health and wellness needs of low-income, high risk individuals in the neighborhoods we serve.

Through the PHP Foundation, we offer grants to tax-exempt, private agencies and/or public charities in the Indiana and Ohio counties that we serve. These grants, totaling more than $10 million in the past 15 years, have helped fill voids in community needs.

PHP charitable contributions have offered broad social benefits to organizations including Matthew 25, Neighborhood Health Clinics, Super Shot, Inc., Maple City Health Care Center, LOGAN, and others. In addition, more than a million lives have been improved through improved access to medical and dental education, treatment, medications, and more; most often reaching low income, disadvantaged, medically and emotionally challenged individuals.

Academic Scholarships

For 30 years, PHP has awarded academic scholarships to high school seniors in our service area pursuing careers in health-related fields. Nearly 100 students have received a total of more than $150,000 for educational expenses at a college, university, or technical school.

View our 2023-2024 downloadable application here. All entries must be submittted and postmarked no later than Friday, February 23, 2024. 

Regional Branding Initiatives 

Northeast Indiana is in the middle of it all, located just three hours or less by car from Midwest cities including Chicago, Cincinnati and Indianapolis –but with its own unique vibe and easygoing lifestyle. Here, we offer the opportunity to create your version of the American dream, whether you’re looking to grow your career, family or home.

At PHP, we believe in celebrating individual and team achievements such as Years of Service anniversaries and team project successes. The diverse experiences and expertise of each PHP team member is an advantage over our competition and gives us reason to celebrate.

 

Ready to join the PHP team?

Check out these current opportunities:

 

Want to receive alerts when new openings are posted? Set up an account with just a few pieces of information.

Get in touch with us using one of the options below and let PHP start serving you today.

PHP's weekday lobby hours are 8:00 AM - 3:00 PM.

Online Chat is also available through your member account weekdays from 8:00 AM - 5:00 PM.

We answer phones on weekdays from 8:00 AM - 5:00 PM. If you leave a voice message, we will return your call within 24 hours.

If possible, please leave the following information when leaving a voicemail:

  • Name
  • PHP ID number (if you are a member)
  • Contact information (phone or email)

PHP is a Fort Wayne, Indiana based employee benefits company. While we are licensed to sell our traditional full-risk products and services in 46 Northern Indiana counties and 6 Ohio counties, our self-funded health plans and administrative services are available throughout both states. Additionally, PHP's network coverage extends beyond this service area to provide comprehensive choice in doctors, hospitals, facilities, and pharmacy access for our members across the country.

If you're an employer and you'd like to get PHP insurance coverage for your employees, click here to get started.

Our Values: What is Important to Us

  • Innovation – We embrace an environment that encourages free thinking, new ideas, and a nimble response
  • Collaboration – We are an agile team that identifies and implements strategic solutions
  • Integrity – We act and speak honestly and ethically
  • Development – We provide opportunity for employee growth, both personally and professionally
  • Social Purpose – We are committed to philanthropy, actively involved and supportive of the communities we serve

Our Mission: Why We Exist

To create innovative solutions that contribute to healthier communities through caring and collaboration.

If you are a media outlet looking for more information on PHP, please contact:

Michelle Kearns
Marketing Communications Director
mkearns@phpni.com
260-432-6690, ext. 463

About PHP-Employee Benefits

PHP, headquartered in Fort Wayne, Indiana, was established in 1983 by area physicians, and has grown to 180+ employees serving nearly 65,000 members. PHP’s products include group health, dental, prescription drugs, life, disability, Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements (HRA). PHP’s TPA Services division offers comprehensive employer Third Party Administrative services, cost containment solutions as well as self-funded administrative services for medical, dental, vision, prescription drugs, short term disability, Health Savings Accounts (HSA) FSA, HRA, and COBRA.

These commonly used terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms might not use the exact same definition in your policy or plan. Be sure to review your Summary of Benefits and Coverage for information on your specific plan or policy.

1) Provide increased access to data

Health industry data can't (and shouldn't) be locked and guarded in the silos it's been isolated in up until now. Data must be available to the ones who can use it to improve healthcare quality while lowering costs by tracking performance and measuring action plans and their outcomes.

2) Share knowledge and learn from others

With a unified goal in mind, sharing knowledge outside of organizational walls will reduce financial waste, improve workflow, and provide evidence-based content to enable a faster, easier learning curve.

3) Develop strategies through assessment

First, determine your current status, strengths, and weaknesses. Look at your plan for the next several years and determine where you can best implement your strategies for value-based reimbursement.

Become a Participating Provider

Participating providers are able to provide services to our members as part of our plan networks. If you would like to become a part of our network, you will need to complete the credentialing process.  Get started by downloading one of our credentialing forms or by filling out the online form below.

Become a Member Physician

Member Physicians not only provide services to our members, but also participate in the governance of our plan. As a member physician, you would have a say in developing and maintaining a local, not-for-profit health plan that is an alternative to the big insurance plans out there today.

To become a member physician, contact:

Dawn Dager
Contracting Specialist
1-800-982-6257, ext. 304
ddager@phpni.com

If you have any further questions, please contact our Provider Relations team by completing the form below.

Download our Credentialing Criteria brochure.

Thank you for your interest in becoming a provider with Physicians Health Plan of Northern Indiana (PHP). Providers who would like to apply to be a participating provider must first complete and return the following to our Credentialing Coordinator:

The completed documents may be sent to our Credentialing Coordinator at providerservices@phpni.com or via fax at 260‐436‐4809. For questions about initial credentialing, re-credentialing requests, and related information, contact:

The Credentialing Process

Thank you for your interest in becoming a provider with Physicians Health Plan of Northern Indiana (PHP).

Step 1

Send your Participation Application Request Form, a copy of your professional liability insurance cover sheet or declaration sheet, and your unrestricted state license or certification to our Credentialing Coordinator at providerservices@phpni.com or via fax at 260‐436‐4809.

Step 2

We will review your documents and you will be sent directions for completion of the Council for Affordable Quality Healthcare (CAQH) application for practitioners. This process includes primary source verification of key elements of your application.

Step 3

Once the verification process is completed, you will be notified within 10 business days of the recommendation of the Credentials Committee, and if eligible you will be contacted by the Provider Services Department to initiate contracting with PHP.

Initial Credentialing

The following provider types are required to successfully complete the credentialing process:

Physicians:

  • Doctors of Medicine
  • Doctors of Podiatry
  • Doctors of Osteopathic Medicine
  • Doctors of Dentistry (including oral maxillofacial surgeons)

Allied Health:

  • Nurse Midwives
  • Chiropractors
  • Optometrists
  • Nurse Practitioners in Independent Practice
  • Clinical Nurse Specialists
  • Doctorial & Clinical Psychologists
  • Master’s Level Clinical Social Workers
  • Addiction Counselors
  • Licensed Mental Health Counselors

Facilities:

  • Long & Short Term Acute Care Hospitals
  • Home Health Agencies
  • In‐patient Rehabilitation Hospitals
  • Specialty Facilities such as Cancer Hospitals and Birthing Centers
  • Ambulatory Surgical Centers
  • Behavioral Health Hospitals
  • Skilled Nursing Facilities

Upon receipt of the completed Participation Application Request Form and attached documents, your request will be reviewed and if you meet the requirements, you will be sent directions for completion of the formal application. As required by the State of Indiana for Health Plans, PHP utilizes the Council for Affordable Quality Healthcare (CAQH) application for practitioners. If you are not already a registered user, you will be sent directions on how to access the application. Facility providers will be sent directions for a separate application.

Once the application has been completed, attestations signed, and our Credentialing Department notified, the formal credentialing process begins. This process includes primary source verification of key elements of your application. Should incomplete, inaccurate or conflicting information be identified, the applicant will be contacted and given an opportunity to correct the information and resubmit it to the Credentialing Department. It is the applicant’s responsibility to work with the organization that reported the inaccurate, conflicting or incomplete information to get it corrected. The applicant, at any time during the credentialing process, may also contact the Credentialing Department to check the status of their application. Once the verification process is completed, the applicant will be notified within 10 business days of the recommendation of the Credentials Committee.

Once the credentialing process is complete, you will be contacted by the Provider Services Department to initiate contracting with PHP.

Recredentialing

At least every three years from the date of the initial appointment, providers will be recredentialed and evaluated for continued participation in the PHP Network. The CAQH application is again used, and the provider should keep this application form up‐to‐date. An updated signed attestation form will also be required. Information that may have changed since your initial application will be verified with the primary source. If inaccurate, conflicting or incomplete information is identified, the provider will again be contacted and given an opportunity to correct the information and resubmit it to the Credentialing Department. It is the applicant’s responsibility to work with the organization that reported the inaccurate, conflicting or incomplete information to get it corrected. At any time during the recredentialing process, the provider may contact the Credentialing Department to check the status of their recredentialing.

At the conclusion of the recredentialing process and recommendation of the Credentials Committee, the provider is considered to be recredentialed unless otherwise notified. Providers will be notified by letter when the recommendation of the Credentials Committee is other than full reappointment. This letter is sent within 10 business days of the recommendation of the Credentials Committee.

Hospital Based Providers

Providers who are strictly hospital based, such as Emergency Department Physicians, Hospitalists, Radiologists, Pathologists, hospital‐based Nurse Practitioners or Clinical Nurse Specialists, and any other providers who only see patients as a result of them being admitted or directed to a specific hospital are not listed in our Provider Directory, and are therefore not required to be credentialed in order to participate in the PHP Network.

However, if the provider is listed in our Provider Directory, or has a private practice outside the hospital, they must go through the formal credentialing process.

Other Health Service Individuals or Organizations

PHP contracts for many types of health services provided by individuals or organizations that are not required to be credentialed as described in our Credentials Plan or summarized above. These individuals and organizations must still meet certain standards of participation, which will be verified. Clinical individuals and organizations are required to provide proof of professional medical liability insurance at a level not less than $250,000 per occurrence/$750,000 in the aggregate. There are specific standards to each service type that must be met and PHP will verify these before the contracting process can be initiated.

Please contact the Provider Services Department at 800‐982‐6257, for a list of individuals or organizations that fit in this category and their specific requirements.

Together, we can create a platform for your benefits portfolio that encourages taking cost-effective measures and coupling them with your personalized strategic planning. Our programs include:

  • Utilization Review / Case Management
  • Pharmacy Benefit Manager Relationships
  • Claims Administration
  • Cost Savings and Containment Systems
  • Compliance and HIPAA
  • Fraud Prevention
  • Information Systems, Web Access, and Reporting
  • Plan Administrator Website
  • Wellness Programs
  • Preventive Services Initiatives
  • Benefit Design / Summary Plan Description Development
  • Standard or Custom Administrative Packages

For More Information

John Court
Account Executive, TPA Services
jcourt@phpni.com

1-800-982-6257, ext. 212

Why consider self-funding?

In short, you have more control, lower taxes, improved cash flow, less regulations, and plan flexibility with a self-funded plan.

Increased Financial Control

With self-funded plans, employers have the advantage of using their money for funding claims only when they are due rather than continually funding an insurance company through premium payments. This allows the employer to have greater control over funds that would otherwise be held by their insurance carrier in various reserves, such as unreported claims and pending claims.

By funding claims directly, an employer avoids the insurers’ costs of claim reserves, administrative costs, profit margin, risk charges, premium taxes, and contingency margins—basically, you're cutting out the middleman and likely saving money because of it.

Plan Flexibility

Self-funded plans allow employers ultimate flexibility in designing their own health benefit plan. Because self-funded plans are exempt from state insurance laws, employers have more control over where their claim dollars are being spent as opposed to insurance carriers who are tied to a variety of laws and restrictions. This allows employers to pick and choose plan options based upon their values, budget, and strategic planning objectives.

Utilization and Plan Management

The design flexibility and ongoing expense analysis of self-funded plans allows employers to continuously make the plan design changes that they need in order to manage their costs effectively. Self-funded plan designs can even include strategies to monitor use and assure appropriateness of care for inpatient and outpatient services, all while maintaining the benefit of discounts from a variety of network partners.

Information Management

In a self-funded plan, employers have secured access to all of the information needed to manage their plan effectively. Authorized individuals will have access to confidential monthly reports and benefit-related information and insured clients will have access to their eligibility, claims, and reporting system through our encrypted website. This allows employers to have greater time control and use of their plan's data.

I'm convinced. Now what?

If you're interested in a self-funded plan and ready to take the next step, we encourage you to contact PHP TPA Services, to get started on creating a customized health plan just for you. Why PHP's TPA you ask? Here are just a few reasons:

  • PHP is an experienced third party administrator with extensive local market knowledge.
  • We can help you design the plan you are seeking to meet employee health needs and suit your bottom line.
  • You'll have access to a dedicated account manager to handle your business needs.
  • You'll have access to a live, local customer service team.
  • Claims administration will take take of your HR needs, plan communication, and ID card distribution.
  • We offer contracted utilization review and medical management cost savings programs.
  • We are technology, HIPAA, and compliance driven.
  • We offer value-added services and wellness initiatives to keep your employees on the job and engaged in their own well-being.
  • Our clients have access to experienced sales management and service-oriented claims payment operations.
  • You will receive guidance on compliance demands, actuarial resources to provide specific guidance based upon available plan data.

For More Information:

John Court
Account Executive, TPA Services
jcourt@phpni.com
1-800-982-6257, ext. 212

Network/ID Card Information

Please show any provider your ID Card at the time of service. Your primary network(s) are displayed on the front of your ID card. Additional network information for traveling outside of Indiana is located on the back of your card.

Need a temporary ID card?

Simply log into your account and select the Member ID Card icon from the menu. From there, you may view or print a copy of your ID card at your convenience. You can also order a new card to be mailed to you, as well.

Where to go for care

When it comes to choosing where to receive care, your choices can make a big difference in terms of cost and convenience. Weigh your options and choose a level of care appropriate for the situation.

Telehealth(Parkview OnDemand)
Doctors Office
Urgent Care
Emergency Room
Cost:
Copay/out-of-pocket expense to you.
Severity:
The seriousness of illness or injury.
Speed:
How quickly you can be seen by a provider.
When to use:

{{selected.category.description}}

Talk to a Nurse, 24 hours a day.

Questions about a medicine that you are taking or symptoms you might be experiencing can come up at all hours of the day and night. It is nice to have a quick response to your healthcare questions. That's why we offer MyNurse 24/7, a toll-free nurse help line for non-emergency situations. This free benefit allows members to speak with experienced, knowledgeable nurses about specific health concerns. Nurses will answer your questions with sound, clinically based information. Since they are available 24 hours a day, 7 days a week, and 365 days a year, you can have peace of mind when it comes to getting the answers you need. Call anytime at 1-800-931-4714.

What should I do in case of an emergency while outside of my service area?

If you are traveling and an emergency occurs, contact the nearest emergency service. It is a good idea to discuss with your doctor what to do in the event of an urgent medical situation before it happens. Being prepared and having information about existing healthcare conditions and any medications currently being taken is important. This information will assist the emergency healthcare providers in their choice of treatment options and can improve your likelihood for a healthy outcome.

Our History

Founded in 1983, Physicians Health Plan of Northern Indiana, Inc., is a physician-sponsored not-for-profit health insurance company whose focus has always been on providing our customers with quality, affordable health care customized to meet the specific needs of our members. Forty years later, PHP remains locally sponsored and governed by area doctors and business representatives who are committed to supporting patient/physician relationships and healthcare options for better health outcomes and healthier communities.

Looks like you and Gerald have reached the end of the course! Let’s catch a cart back to the homepage.