Once enrolled, members will receive a card that shows they qualify for Hillsborough Health Care and that they are a member. Members must bring the cards with them each time they see a caregiver.
Types of Health Care Coverage by Plan Including Exceptions
- Members are covered for all necessary medical services, not including those services listed in the exceptions section of the manual
- The patient’s primary care physician must coordinate all services for these plan members
- 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
- Members require specific authorization from Hillsborough Health Care for each service authorized
- Plan D members are covered for only a specific service
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.