HIP DIRECT PAY
HIP HMO Direct is a New York State mandated Health Maintenance Organization (HMO) program marketed and sold only to the direct pay population. Direct Pay members are those who purchase a policy directly with HIP, rather than purchasing it through an employer group. With the passage of legislation in 1996, Direct Pay members were grandfathered in and allowed to remain in this product - where some still reside - and retain a richer benefit set than what is currently offered to new members covered under HIP HMO Direct. The HIP HMO Direct member is required to select a primary care physician (PCP) who provides and/or coordinates the member's care. The member may be subject to copayments for services. HIP HMO Direct does not offer out-of-network coverage. HIP HMO Direct members can utilize a network of independent physicians who see HIP members (and non-HIP members) in their own offices, or members can access care at multi-specialty group practices.
No out-of-network coverage
PCP and Referrals- Members must select a PCP
- Members must obtain specialist referrals from the PCP
Geographic area: HIP's 10-county NY service area
Plan type: HMO
Implemented: 1/96
HIP Choice Plus Direct is a New York State mandated Point of Service (POS) plan marketed and sold only to the direct pay population in HIP's service area. Direct Pay members are those who purchase a policy directly with HIP, rather than purchasing it through an employer group. There are copayments for in-network benefits. The indemnity piece of this product enables the member to utilize out-of-network benefits with coinsurance and deductible requirements. Prescription drugs, when prescribed by a participating provider, are subject to an annual deductible; HIP Choice Plus Direct does not offer an out-of-network prescription benefit. There is a lifetime maximum for all out-of-pocket costs for all out-of-network benefits. HIP Choice Plus Direct members can utilize a network of independent physicians who see HIP members (and non-HIP members) in their own offices, or members can access care at multi-specialty group practices.
Participating providers are located within HIP's 10-county NY service area.
Plan type: POS
Implemented: 1/1/96
Direct Pay Application
2009 Cost Summary
Benefit Summaries
Choice Plus Direct Pay
HMO Summary of Benefits
