FAQs

HAP representatives are available by phone, email and in person for one-on-one assistance to answer your health insurance questions and assist with on-the-spot enrollment. Call a HAP representative at (855) WITH-HAP between 8 a.m. – 8 p.m. Mon-Sat, or 11 a.m. – 4 p.m. Sun.

Or, visit us at any of our 3 walk-in locations:

HAP Corporate Customer Service Lobby
2850 West Grand Blvd.
Detroit, MI 48202
Mon – Fri 8:30 a.m. – 4:30 p.m.

HAP Tower 14 Customer Service Lobby
21700 Northwestern Hwy.
Southfield, MI 48075
Mon – Fri 8:30 a.m. – 4:30 p.m.

Troy Optimeyes
735 John R Rd.
Troy, MI 48083
Mon – Fri 8:30 a.m. – 8 p.m.
Sat 8 a.m. – 5 p.m.
Sun 11 a.m. – 4 p.m.

TAGS: Customer Service|Contact

Group health plans and health insurance plans that were in place on March 23, 2010, when the PPACA was enacted, are called grandfathered plans and are exempt from some elements of the law. However, to maintain grandfathered status, a plan cannot reduce or eliminate benefits, increase employee cost-sharing above certain thresholds, or reduce the employer share of the premium payment. Once a plan loses its grandfathered status, it must comply with all applicable requirements of the law. It is the employer group’s responsibility to determine if the plan is grandfathered or not.

As shown in the table below, for large group grandfathered and non-grandfathered plans, only the PCORI Fee will be embedded in rates. The Health Insurance Premium Tax, Transitional Reinsurance Program and HICAA Tax will be charged as separate line items.

Plan Type	Embedded	Separate Line Item	Not Charged
Grandfathered and Non-Grandfathered Plans (Effective January 1, 2014	PCORI Fee*	Reinsurance Fee** >Premium Tax** HICAA Tax*	Exchange User Fee

HAP will file form 720 for all fully-insured members enrolled with HAP and Alliance. This filing will not be broken down by employer group, thus we are not able to provide a copy of the filing at the group level.

The final premium tax for HMO accounts for 2014 is 1.15 percent, which equates to a per member per month (PMPM) of approximately $4.46 on average. This was calculated based on HAP’s estimated fee of $14.7 million (50 percent of full fee due to not-for-profit status), which then is broken out between our Medicare and Commercial book of business. For Commercial, based on our projected 2014 premium platform and associated insured member months, we calculate a needed fee of $10.9 million, which results in a charge of 1.15 percent, or $4.46 PMPM.

The final premium tax for Alliance accounts for 2014 is 1.55 percent, which equates to a per member per month (PMPM) of approximately $3.59 on average. This was calculated based on the Alliance estimated fee of $2.7 million, which then is broken out between our Medicare and Commercial book of business. For Commercial, based on our projected 2014 premium platform and associated insured member months, we calculate a needed fee of $2.1 million, which results in a charge of 1.55 percent, or $3.59 PMPM.

Medicare Advantage (MA) plans are not subject to all PPACA taxes. MA plans are subject to the Premium Fee. MA plans are not subject to: Reinsurance, PCORI, Exchange User or Risk Adjustment Fees.

No, these fees apply to small groups and individuals only.

HAP has not yet determined how these fees will be shown on the invoice.

HAP will administer taxes and fees for small groups based on plan type, as shown in the table below:

Plan Type	Embedded	Separate Line Item	Not Charged
Transitional Plans (Plans renewed in 2013 that extend into 2014 and are not grandfathered)	PCORI Fee*	Premium Tax HICCA	Exchange User Fee
Grandfathered	PCORI Fee*	Premium Tax HICCA	Exchange User Fee
Essential Health Benefits Plans (PPACA-compliant)	PCORI Fee* Premium Tax Exchange User Fee HICCA

The HICCA Tax and PCORI Fee are already in effect. All other taxes and fees for small groups are effective on Jaunary 1, 2014 or upon renewal.

All Essential Health Benefit (PPACA-compliant) plans will be subject to the Exchange User Fee, regardless of whether they are purchased on- or off-exchange (Health Insurance Marketplace). The Exchange User Fee pays for access to marketplaces facilitated by the federal government, and is spread across all individual and small group products effective on or after January 1, 2014.

For small group plans issued or renewed on or after January 1, 2014, the Michigan Marketplace defines a small employer as two to 50 full-time equivalent employees (FTEs).

All non-grandfathered small-group plans issued or renewed on or after January 1, 2014, must comply with the law’s new, adjusted community rating rules. Premium prices can be determined using the following four factors:

• Per Member/Per Month (PMPM) rating: Premium cost by member, rather than tiered contract, capped at the three highest priced dependents, not including spouse or dependents 21 or older
• Geographic rating: Michigan has defined 16 geographic areas in the small group market; rates will be based on the employer’s primary zip code
• Age rating ratio: Members of a small group, age 21 and older, cannot be charged more than three times the rate of a younger person for the same policy (HAP will use a prescribed age curve for ages 21 to 64)
• Tobacco ratio: Tobacco users cannot be charged more than 1.5 times the non-tobacco users’ price

Note that these factors do not include health status, gender, or industry type.

The application will take minimal time to complete. The applicant should be certain to have key information needed to enroll everyone on their contract such as names, birthdates and SSN. It’s also suggested that applicants determine their plan selection prior to starting the application process.

Coverage will take effect once the application is submitted and payment is received. Effective dates are the first of the month and follow the rules below: The effective date of coverage will be determined based on the date that we receive a fully completed application.

• If the application is received on or before the 15th of the month, coverage will take effect the 1st of the month following
• If the application is received on the 16th through the end of the month, coverage will take effect the 1st of the second following month.

Example: If an applicant applies and is accepted for coverage by December 15th, coverage will take effect on January.
If the applicant applies and is accepted for coverage by December 16th, coverage will take effect on February.

We do not suggest that you cancel existing coverage until you have been fully enrolled and your effective date of coverage in your new plan has been confirmed. To avoid paying duplicate premiums, it is best to “match up” the termination date of existing coverage with the start date of new coverage.

You may enroll online, complete a paper application or visit us at our retail sites where we have Personal Alliance experts to assist you. You may also call us at (855) 948-4427 and we can enroll you over the phone in our Personal Alliance products. Here’s where you can come and talk with us:

Health Alliance Plan 21700 Northwestern Hwy Southfield, MI 48075

Health Alliance Plan 2850 W. Grand Blvd. Detroit, MI 48202

Henry Form OptimEyes Troy Super Vision Center 735 John R. Rd. Troy, MI 48303

If you are applying for coverage through HAP you have three payment options available to you. In the application process you can select credit card or EFT. The banking information must be included in the application process. Or, you can select the “bill me” option. A bill will be sent to you and will include the date that payment is due. You do not actually include a payment with your application.

Rates are filed and approved through Michigan’s regulatory agency and approved on an annual basis. Outside of the formal rate approval process, members could experience an increase or decrease could occur to their rates if any of the following occur:

• The family composition changes - new dependents are added or removed from the contract
• The member moves to a new geographic location
• The member switches plans due to a life event and the plan premiums are higher/lower than initial plan

Applicants can be enrolled in our products from newborn through 64 and 11 months of age. Dependents may apply for coverage on their parent’s contract prior to age 26. A 26 year can apply for coverage under his/her own contract. Stepchildren and legally adopted children who are legally dependent on the primary applicant are eligible to apply for coverage. When members reach age 65 they will be re-directed to a HAP Medicare product for coverage.

If you made false statements on your application, filed fraudulent claims, obtained duplicate coverage or failed to pay your premiums on time, HAP can cancel your policy. HAP cannot cancel your policy because of your health (current or previous) or claims history.

For 2013 plans a Personal Alliance member cannot come in and out of coverage multiple times within a year. If a member was enrolled in a Personal Alliance product within the past 12 months, they cannot drop and add coverage within the same benefit period.

For 2014 plans a personal Alliance member can change coverage during the open enrollment period each year. There are exceptions for enrollment or a change in coverage within 60 days of a life-changing event, such as the loss of a job, salary change, death of a spouse or birth of a child.

None of the provisions affecting individual consumers – adults under 65 who do not have access to health insurance through an employer – have been delayed.

You can purchase HAP coverage from the Marketplace, but because you have access to coverage through your employer, you will not be eligible for financial assistance. With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

If you have access to health insurance through your employer, you can shop for coverage through the Marketplace, but you will not be eligible for financial assistance. With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

If your company drops health insurance for employees, you will be able to buy individual or family coverage, either directly from a health plan like HAP, or through the Health Insurance Marketplace. And, low- and middle-income individuals and families may be eligible to receive financial assistance through the Marketplace.

The Health Insurance Marketplace will offer, for individuals only, a catastrophic health plan that will cover the Essential Health Benefits, but only after a high deductible is met. Members won't have to pay the deductible for preventive care or for up to three primary care visits per year. Eligibility for the catastrophic health plan is restricted to either (1) young adults under age 30 prior to the start of the plan year or (2) individuals who get a "hardship exemption" from the Marketplace because they're unable to afford any other available health coverage.

The monthly premium should be lower than other health plans offered in the Marketplace, but the out-of-pocket costs for copays, deductibles, and coinsurance are higher. In addition, catastrophic plans don't qualify for the premium savings and lower out-of-pocket costs that are available to low- and middle-income individuals through the Marketplace, so it's important to carefully compare all options.

Grandfathered plans are those that were already in place on March 23, 2010, when the health care reform law was enacted, and that have stayed largely the same since that time. Grandfathered plans are exempt from some health care reform provisions. For example, a grandfathered individual plan does not have to guarantee coverage for people with pre-existing medical conditions or end yearly dollar limits on coverage. However, it's important to note that some grandfathered plans may offer benefits that are not required.

Even if you joined a plan after March 23, 2010, the plan may still be grandfathered. The status depends on when the plan was created, not when you joined it. You can find out if your plan is grandfathered by checking your plan’s materials. Health plans must disclose if they are grandfathered in materials describing plan benefits. You can also check with your employer or your health plan’s benefits administrator.

A consumer who is a member of a federally recognized Indian tribe may also be eligible for special cost-sharing rules. Certain American Indians and Alaska Natives who purchase health insurance through the Exchange do not have to pay co-payments or other cost sharing if their income is under 300 percent of the FPL, which is roughly $70,650 for a family of four in 2013 ($88,320 in Alaska).

Although the premium savings in the health care reform law don't apply to Medicare, there are a number of financial assistance programs available to help you pay your Medicare expenses if you are elderly or disabled with low income and limited assets. To find out if you might qualify, you should call your local Department of Human Services (DHS) office (in the telephone book under County Government or State Government) or look for your local DHS office online at www.michigan.gov/dhs DHS will send you an application, or it can be found and printed online at www.michigan.gov/dhs.

If you are getting COBRA coverage, you may find that there are already lower-cost individual health insurance options available to you through HAP.

Starting in 2014, health care reform will include financial assistance for low- and middle-income individuals who qualify based on their income and family size. Financial assistance will be available only through the new Health Insurance Marketplace, which will offer a wide variety of health plans, including HAP plans. If your COBRA coverage runs out or if you choose to end it, you will be able to change from COBRA coverage to Marketplace coverage at any time, even if it's not during the annual open enrollment period.

As is now the case, you will be able to choose from a wide variety of private health plans, and decisions about your care will be made by you and your doctor.

Your coverage for the care you receive will depend on the kind of health plan you choose. Your health plan will provide you with a detailed description of what is covered and what is not, along with a simplified Summary of Benefits and Coverage (SBC) that includes information on copays, coinsurance, and deductibles. The SBCs include examples of how much a member would typically pay in out-of-pocket costs for two medical scenarios: childbirth and treating type 2 diabetes.

The Affordable Care Act guarantees your right to appeal a health plan decision. Private insurance plans have to tell you why a claim has been denied and they have to let you know how you can dispute their decision.

Insurance you get through an employer is called “group” health insurance, meaning the rates are determined based on everyone in the group. Individual and family health insurance rates are calculated much like your car insurance – they're based on the people covered. HAP quotes take into consideration your age, where you live, tobacco use, and family composition.

Use our online provider search to see if your doctor(s) and/or hospital are in the HAP network. View the provider details to ensure that your doctor accepts your plan type.

HAP offers a wide range of weight management programs for members to choose from (participation is voluntary):

• Weight Watchers at $25 per 12-week session (up to four sessions per lifetime)
• Clinical weight loss programs (several hospital-based weight management programs are covered by HAP when referred by a physician)
• Nutrition Counseling
• Weight loss medications
• Online health resources
• Online wellness program called iStrive® BALANCE®

HAP offers several programs to help members quit smoking. While you are not required to quit in order to have HAP coverage, rates may be lower for non-smokers.

Our smoking cessation programs include:

• Smoking (tobacco/nicotine) cessation counseling services provided by your doctor
• Henry Ford Medical Group's Smoking Intervention Program (SIP)
• Henry Ford Health System Freedom from Smoking
• Prescription and over-the-counter tobacco/nicotine cessation drugs or products, such as patches, gum, nasal spray or inhaler
• Electronic counseling services with the iStrive® BREATHE® program

You can see a doctor on your effective date of coverage. Coverage will be active once the application is processed and full approved and premiums payments are received.

Yes, but only for HMO plans. Your PCP is central to your individual care and will assist you by directing you to specialty services and elective procedures, as needed. For PPO plans, you do not need a PCP, but we recommend having a primary, go-to, doctor.

If you have an HMO plan, your PCP will direct you to specialists when needed. HAP has simplified access to specialty care, providing paperless referrals and reducing the need for most referrals. For PPO plans, you do not need a referral.

To begin a prescription on your HAP coverage you should first finish your existing prescription as directed by your doctor. When you are ready for a refill or need to start a new prescription contact your HAP doctor. Be sure to provide your HAP ID card at the pharmacy.

HAP is affiliated with many local and national pharmacies, including Target, Kroger, Meijer, CVS, Rite Aid and Walgreens. To find a pharmacy use our online pharmacy directory.

Yes. Emergencies and urgent care services are covered worldwide. HAP also offers members’ access to Assist America® which provides global emergency and other services for members who are traveling more than 100 miles from home or to another country.

Your student is covered through HAP's Students Away program. Also, students covered by HAP have access to Assist America when they are 100+ miles away from home or in another country for less than 90 consecutive days. Emergency services and urgent care are always covered.

Urgent care or emergency services are covered worldwide. Routine services are covered within the HAP network. Services outside the network may be covered if you have a PPO plan

HAP's Continuity of Care program allows members to continue to receive medical care from their current health care provider if you are currently involved in an active, covered treatment plan that if interrupted, could seriously affect your health.

New members should contact our Client Services department to begin the process at (800) 422-4641. HAP will transfer you to an affiliated provider when possible, without disturbing the care being provided through your current treatment plan.

We offer HMO, PPO and EPO plans with a variety of cost-sharing options. Plans can include copays, coinsurance and/or a deductible.

Our HMO plans are community-rated and our PPO/EPO fully insured plans are experience-rated. The self-funded plan is the fixed cost plus the claims expense less any stop-loss reimbursements

The HMO market area includes the counties of the HAP nine county market area:

• Genesee
• Lapeer
• Livingston
• Macomb
• Monroe
• Oakland
• St. Clair
• Washtenaw
• Wayne

The PPO/EPO market area includes these 9 counties plus 15 more:

• Arenac
• Bay
• Clare
• Gladwin
• Gratiot
• Huron
• Iosco
• Isabella
• Midland
• Ogemaw
• Roscommon
• Saginaw
• Sanilac
• St. Clair
• Tuscola

Yes, Health Savings Accounts (HSAs) are an optional feature for all of our HMO, PPO and EPO plans.

The HAP claims department is available at (866) 766-4661.

Producers & Employer Groups with questions about member specific services should call (800) 950-7455 or email hap_direct@hap.org 8 a.m. to 5 p.m. Monday through Friday.