Atlantis Health Plan Member Handbook- POS
As an AHP member, your benefits package is one of the most comprehensive available today. Basic primary care and preventive benefits are available. These benefits include periodic physical examinations, annual gynecological examinations and pap smears, well-baby care and immunizations (In-Plan only), routine mammograms, health education services, periodic eye and hearing examinations, routine allergy injections, treatment for routine illness or injury as well as after hours, or urgently needed care.
All covered services must be medically necessary. Except in an emergency, most In-Plan services must be directed, referred, or prescribed by your Primary Care Physician, as more fully described in the Summary of Benefits and your Subscriber Contract.
When using In-Plan benefits, you will be responsible for copayments for certain professional services. A copayment is a portion of the cost of the service that you are responsible for at the time the service is received.
Copayments for professional services apply to most "visits" to a physician or other provider. Copayments are on a "per visit" basis so that a visit to a provider that involves more than one service, for example, a visit to an OB/GYN that involves lab tests, will only be subject to a single copayment.
Copayments are not applicable to services that do not involve a visit, for example, ambulance and durable medical equipment.
Copayments are not applicable to use of institutional services (admissions to hospitals, skilled nursing facilities or hospices), or ambulatory surgical facilities.
Please refer to the Summary of Benefits in your AHP Subscriber Contract for all applicable copayments.
When accessing Out-of-Plan benefits, you will be financially responsible for a certain accumulated amount before Atlantis begins reimbursing for services. This amount is referred to as the contract deductible.
Deductibles are per calendar year and apply to all enrollees in the Contract. Expenses incurred in the last three months of a calendar year may not be carried over and applied to the deductible for the ensuing year. The Schedule of Benefits reflects the deductible you and any covered family member(s) must meet. Please remember that only covered services are applied to the annual deductible.
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