Frequently Asked Questions

An unmarried dependent child may continue on the plan beyond the dependent limiting age if:

• The child is incapable of self-sustaining employment due to mental or physical disabilities,
• The child is primarily reliant on the employee for support and maintenance,
• Proof of incapacity and dependency is given to PHP within 120 days of reaching the limiting age, and
• The child remains incapacitated and dependent, unless coverage otherwise ends under the contract.

Continued incapacity and dependency may be periodically verified at PHP’s discretion.

• The Subscriber’s legal spouse;
• A child who is under 26 years of age and a United States citizen or legal resident of the United States and: 
  • A son or daughter of the Subscriber regardless of support level; or
  • A step-child, child subject to legal guardianship, grandchild or other blood relative who depends on the Subscriber for more than 50% of total support;
• Any child of the Subscriber who is recognized under a Qualified Medical Child Support Order (QMCSO) as having a right to enroll under the Contract.

PHP's goal is to provide quality products and superior service. Questions about benefits, eligibility, claims payment, prior authorization, or the participation status of doctors, hospitals, or other facilities can be addressed by our Customer Service Department.

PHP Customer Service Department

260-432-6690, Extension 11
1-800-982-6257, Extension 11
260-459-2600 for the hearing impaired
custsvc@phpni.com

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

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

If your card has the PHP logo in the upper left corner, Physicians Health Plan is your healthcare insurance company.

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