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Medical Coverage
Plan Information
Once a member has been enrolled the member will receive a card that shows that he / she qualifies for Hillsborough Health Care and that they are a member. The member must bring their card with them each time they go to their doctor for care.

Types of Health Care Coverage by Plan Including Exceptions
  • Plan A
    Members are covered for all necessary medical services, not including those services listed in the exceptions section of this manual. The patient’s primary care physician must coordinate all services for these plan members.
  • Plan J
    Members are covered for all Plan A services with the exception of inpatient facility charges. Plan J members are enrolled in the Medicaid Medically Needy program and must take their inpatient hospital bills to their Medicaid social worker.
  • Plan C
    Members are covered for all Plan A services, not including those services listed in the exceptions section of this manual, with the exception of in-patient facility charges and home health services as these are covered by Medicare, Part A. Plan C members are active Medicare, Part A only.
  • Plan D
    Members require specific authorization from Hillsborough Health Care for each service authorized. Plan D members are covered for only a specific service.
  • Plan V
    Members are veterans who are eligible for services from the Veteran’s Administration. Veterans are covered by Hillsborough Health Care for emergency room services and emergency hospitalization until sufficiently stabilized for transfer to a Veteran’s Administration Hospital. Plan V members are also eligible for emergency dental services. No veteran whose income is over 100% of the Federal Poverty Guidelines will be considered for services.
  • Plan M
    Retroactive authorization for payment of emergency room physician services as well as a follow up physician visit up to 30 days after discharge. Plan M does not cover hospital charges, home health care, durable medical equipment, prescription drugs, or medical supplies.

Exception Codes
Some patients have an exception code on their health care card. The codes are as follows:
  • XX: Patient has other coverage plan which may be primary payer, i.e. automobile insurance, etc.
  • YY: Patient has a specific illness or injury that is covered by another payer, i.e. worker's compensation, victims of crime compensation, vocational rehabilitation, etc.
  • MN: Patient has Medicaid Medically Needy program. Inpatient facility charges are not covered for payment as Medicaid is primary payer.

Hillsborough Health Care is not a second party payer for any service covered by another payer resource although coordination of benefits may be considered for certain limited types of coverage such as auto insurance personal injury protection.