How your health plan works
When you join the HealthPartners® Freedom Plan (Cost), you do not need to select a primary care clinic and you may see any medical provider without a referral. To get the highest level of coverage, health services must be provided or arranged by a network physician except for emergencies, out-of-area urgently needed care, or as covered by the Extended Absence benefit. If you get routine care from out-of-network providers without activating your Extended Absence benefit, you will still be able to use your Original Medicare benefits but will be responsible for Medicare deductibles, coinsurance and any additional charges not covered by Medicare.
Getting care
A personal relationship with a physician is at the heart of good care and good health. That's why we encourage you to choose a personal physician who gets to know you and your health history, even though you can go to a different provider each time. Your personal physician can provide most of your care and recommend specialists if you need special care.
Specialty networks
In the HealthPartners® Freedom Plan (Cost) network, you can go directly to any specialist that accepts Medicare without a referral.
When you travel
With the Extended Absence Benefit, you can use your plan's benefits for no additional premium for up to nine months while you are away from your service area. Once activated, you have the freedom to use your Medicare and plan benefits for non-emergency services from physicians and hospitals that are not part of the plan's network. This option can only be used outside the service area and within the United States. You must activate this benefit before leaving the service area each time.
To activate your Extended Absence Benefit, please contact Member Services or log on to your account on HealthPartners.com. Simply present your Medicare member card at the time you get the services. You must see out-of-service-area providers who participate in the Medicare program. In most cases, the doctor or clinic will bill Medicare directly. If a doctor or clinic bills you directly, please submit the bill to HealthPartners to determine your level of benefits. DO NOT PAY THE BILL until HealthPartners has processed the claim. HealthPartners will notify you of any remaining charges due to the provider.
The Extended Absence benefit does not cover preventive or comprehensive dental services.
Emergency care
Emergency services are covered worldwide. In an emergency, go to the nearest hospital or emergency medical center, or call 911. If you receive emergency care that results in an admission to an out-of-network hospital, if possible, call the CareCheckSM program at 800-942-4872 within two working days or as soon as reasonably possible. This will help us manage your care effectively and ensure that you get the maximum benefit coverage possible under your contract. A medical emergency is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse.
Urgently needed care
Urgently needed services are also covered wherever you need them. These are the healthcare services which you need and which cannot be delayed as a result of unforeseen illness, injury or condition under circumstances that make it unreasonable to obtain services through the health plan's network of doctors. If you need urgent care while you are in the service area, go to your clinic or any of the network's urgent care centers.
Coverage for emergency and urgently needed care are available worldwide for all HealthPartners® Freedom Plan (Cost) II and III members. Please refer to your Evidence of Coverage for more information. Prescription drugs are not covered outside the United States.
Prior approval
Most medical procedures are eligible for payment under your health plan without prior approval. For a few medical procedures, doctors need to get prior approval. This process was created to safeguard your health and protect you from undue risks from some medical procedures. For certain drugs, there are criteria that must be met before the drug will be approved for coverage, even if it is on the plan's list of generic drugs. Your physician will request coverage on your behalf. Call Member Services if you have questions about the prior approval process.