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About Your Health Plan Benefits for Immigrant Adults and Seniors (HBIA/HBIS) Plan
We want to make sure you get the health care you need. That’s why the HBIA/HBIS plan offers benefits and programs to help keep you and your family healthy. Your HBIA/HBIS plan covers doctor visits, lab tests, mental health care treatment, prescription drugs and much more. From routine care to urgent care, family planning to home health, we’re there for you.
Medical Benefits
What Is Covered?
This medical program offers a full benefit package. The program may cover up to 3 months of health care prior to when you enroll. Some types of care may need approval from your health plan before you are treated. Learn more about prior authorization.
Some of what your plan covers includes:
- Care at a Federally Qualified Health Center (FQHC)
- Vaccinations at a pharmacy or doctor’s office
- Hospital ER visits and inpatient care
- Lab tests and x-rays
- Mental health care
- Dental care
- Vision care
- Transportation services
- Prescription Drugs
Copayments (copays):
Your plan includes copays. These are fixed amounts you pay for covered health care. You usually pay a copay when you get a service. The amount you can be charged will vary. It depends on the service and the provider. Health care provided and billed by a hospital may be subject to copays. Health care that you get from a primary care provider (PCP) is not subject to copays.
No copay or cost sharing can be charged for an Emergency Medical Condition. An emergency is when you have a sudden medical condition with severe symptoms. It can include intense pain. Without immediate medical help, your health and life could be in danger. Some examples of an emergency are:
- Heart attack
- Severe bleeding that won’t stop
- Broken bones
- A car accident with serious injuries
Copays can only be charged for these services:
| Benefit | Benefit | Notes |
|---|---|---|
| Nonemergency Inpatient Hospitalizations | $250 copay per stay | An Inpatient Hospitalization is an overnight stay in the hospital. |
| Ambulatory Surgical Centers and Outpatient Services: Up to 10% of the Medicaid payment. The amount you can be charged will vary. It depends on the service. Your provider can tell you the amount you will be charged before you get a service. | 10% of the allowed amount | Ambulatory Surgical Centers are facilities where surgeries that do not require a hospital stay are performed. |
What Is Not Covered?
Some services that are not covered include:
- Home and Community Based Waiver services
- Transplant services (these are limited to kidney transplants and inpatient stem cell transplants)
- Long-Term Care facility services
Check the HBIA/HBIS Member Handbook to learn more about what your plan covers.
MEMBER RESOURCES
Helpful Tools and Resources
Find a Doctor or Hospital
Our Provider Finder® makes it easy to search for providers in your area.
Find a Provider
Transportation Services
Learn how you can get a no-cost ride to your medical appointments.
Schedule a Ride
Forms and Documents
For details about your plan, check your Member Handbook.
Go to Forms and Documents