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Atlantis Outpatient Centers


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Introduction

Who Are We?

Atlantis Health Plan is a wholly owned subsidiary of Atlantis Health Systems, Inc., a business corporation started and owned by doctors in the New York City area. As managed care has grown doctors and patients have been increasingly concerned about who makes decisions regarding health care. Patient´┐Żs worry that needed treatment will be withheld or delayed. By participating in Atlantis Health Plan, your doctor is taking back control of patient care from insurance companies.

Atlantis is an HMO, not a traditional indemnity insurance plan. It shares with other HMOs, belief in coordination of care by a Primary Care Provider (PCP). In Atlantis Health Plan, your PCP makes decisions regarding your care and coordinates needed health care services. Atlantis Health Plan works in partnership with your doctor to provide optimal care and keep costs down.

Atlantis, through the Group contract, provides Point of Service coverage. Atlantis provides you with an extensive network of participating doctors and hospitals from which to choose. For added flexibility, as a Point of Service Member, you may choose to see doctors who do not participate with Atlantis. Please take the time to read this Certificate of Coverage carefully so you are aware of the benefits available through your Point of Service Plan. Please note that all day and visit limitations on benefits are combined limitations regardless of whether services are received in-Plan or out-of-Plan. Benefits that are received out-of-Plan will probably not be as comprehensive as benefits received in-Plan. Therefore, it is very important to obtain Preauthorization for out-of-Plan benefits for inpatient admissions and elective surgical procedures. There will be a penalty of 50% of the cost for each non-certified occurrence. For all other out-of- Plan benefits, you are encouraged to call Atlantis prior to receiving such services to determine coverage and cost sharing arrangements.

Subscriber Certificate of Coverage

This document describes the health insurance benefits provided by Atlantis Health Plan (´┐ŻThe Plan´┐Ż or ´┐ŻAtlantis´┐Ż) to Subscribers ("You") and your Eligible Dependents (´┐ŻMembers´┐Ż). This Certificate of Coverage, along with the MEMBER HANDBOOK, will serve as your guide to accessing services. Please read this Certificate of Coverage carefully and share the information with your family.

If you have any questions about your health care benefits or the information in this Certificate of Coverage, please call our Member Services Department at (212) 747-0877 or toll-free at 1-866-747-8422.

We look forward to serving your health care needs.

Sincerely,

ATLANTIS HEALTH PLAN

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