Coverage Types

Commercial – If you have PHPMM through your job, or have a direct (Individual, Non-Group, or Conversion) policy with PHPMM, you have this product.

FamilyCare – If you have PHPMM through Medicaid, you are a member of this product.

PHPMMIC – If you have PHPMM Insurance Company (PHPMMIC) through your job, or have a direct policy with PHPMMIC, you have this product.

Self-Funded – If your employer funds their own benefit plan, but contracts with Physicians Health Plan TPA for administrative (claims processing, enrollment, network) services, this is your plan. Hint: If your member number begins with the number 4, you are part of a self-funded plan.

Definitions

Accepting New Patients (Commercial, FamilyCare and PPO) – Practitioner accepts both new patients and current patients who change from other health plans.

Board Certified – Being "board certified" means a doctor has completed a training program in a specialty and has passed an exam to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care physicians also may be certified as specialists. While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from physicians who are not board certified.

Primary Hospital Privileges (Commercial, FamilyCare and PPO) – Primary hospital that has granted practitioner permission to admit patients or send patients to for care. Practitioners may have additional privileges at other hospitals.

Medical School Attended – The school the practitioner attended before post-graduate education and before starting to practice medicine.

Mental Health and Substance Abuse Providers – Providers that offer services covered by a member’s Mental Health and Substance Abuse benefit.

Non-English Languages – Languages other than English that the practitioner may speak.

Quality Measures – Indicates a score of 80% or greater for Quality-based measures. Only Primary Care Physicians (PCPs), with 50 or more members are eligible for Physicians Health Plan of Mid-Michigan quality measurement. This may include general practitioners, family practitioners, internal medicine physicians, pediatricians, some nurse practitioners, and some obstetricians and gynecologists. This does not apply to other types of physicians/providers or PCPs with fewer than 50 members.

Practitioners – Any nurse practitioner, podiatrist, dentist, chiropractor, optometrist, or other non-MD or non-DO acting within the scope of his or her license.

Primary Care Physicians (PCPs) – A network physician that you select to be responsible for providing or coordinating all covered health services. The physician’s practice generally includes pediatrics, internal medicine, obstetrics/gynecology, family practice or general practice.

Specialists – A network physician who has advanced medical training in one clinical area of care.