The members’ plan benefit document describes their healthcare benefits. All coverage is subject to the terms, conditions, exclusions, and limitations outlined in the benefit document.
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.
For HMO members, services and supplies not provided by or under the direction of a participating provider, except in cases of an emergency or through the request for non-participating provider process, are not considered covered benefits.
PPO members may seek care from out of network providers, in accordance with their benefit documents.