The member is provided the appropriate document describing his/her healthcare benefits upon enrollment. These documents outline all terms, conditions, exclusions, and limitations of coverage.
To be considered medically necessary, the service must not be for care that is provided primarily for the convenience of the MHP member of healthcare provider.
To be considered medically necessary, the service must not be for care that is provided primarily for the convenience of the MHP member or healthcare provider.
Benefits may be subject to co-payments or co-insurance as selected by the member or the member’s employer. Co-payments may be a flat dollar amount paid at the time of service for office visits or a flat fee per diem/per admission for hospital-based services. Co-insurance is a percentage of the payment rate negotiated between MHP and participating physicians, hospitals, health professionals or other providers for certain services.
Co-payments for many services are indicated on the member’s identification card.
Emergency services rendered by participating/ or non-participating providers.
MHP covers the costs for medically necessary emergency care rendered by participating/ and non-participating providers to a member.