Health Care Coverage Plans

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

  • Plan A
    • 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

  • 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 D
    • Members require specific authorization from Hillsborough Health Care for each service authorized
    • Plan D members are covered for only a specific service

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.