Welcome to Your HPN Balance HMO Plan

What’s a Health Maintenance Organization (HMO) health plan?

HMO plans provide members with lower premiums, copays and out-of-pocket costs when compared to most other types of health plans. Your plan provides coverage for medical care, behavioral health, and pharmacy benefits.

Balancing value with cost. Balance HMO plans provide more first dollar coverage to simplify the health care experience and give members more predictable cost share.

Key things to know about a Balance HMO plan:

• You have a full HMO network.
• Your HPN Balance plan pharmacy network includes Walgreens, Smiths Food & Drug, VONS, Albertsons/Sav-on. Your pharmacy network does not include CVS Pharmacy, CVS Pharmacy inside Target, Walmart and Sam’s Club.
• Your HPN Balance plan has a partnership with Walgreens that allows you to get up to a 90-day supply of your medications.
• You are required to have a primary care provider (PCP). Your PCP will be the leader of your health care team and help with preventive care, referrals and other health care services.
• You can change your PCP at any time.
• You need to get your care from in-network (contracted) providers.
• You need a referral from your PCP in advance of receiving specialty care. If you don’t get a referral first, you won’t have benefit coverage.
• You need a prior authorization for certain services. Refer to your plan documents for more information.

In exchange for some plan requirements, like those noted above, your Balance HMO plan provides great coverage for a lower cost.

To access your Balance HMO health plan benefits, just show your health plan ID card. Always carry your health plan ID card with you. Show it when you fill a prescription and check-in for your medical appointments.

Programs and services support you when you need care and want to maintain or improve your health.

Care Options

• 24/7 Advice Nurse: Care advice from a registered nurse at 1-800-288-2264, TTY: 711.
• 24/7 Virtual Visits: Video chat with a provider for non-life-threatening and non-urgent medical conditions. Same-day medication delivery (restrictions apply). Download the NowClinic app or visit NowClinic.com.
• Urgent Care House Calls: Home urgent care visit when you aren’t feeling well enough to travel. Call the 24/7 advice nurse for more information.
• Urgent Care: Care for non-life-threatening but urgent needs.
• 24/7 Emergency Care: Treatment for the sudden onset of life-threatening needs.

Wellness Programs

• Weight Loss Program: Spark your transformation for $0 copay.
• Healthy Rewards: Build healthy habits and earn rewards.
• Wellness Classes: Help to live a healthy life with classes taught by certified health educators.
• Online Wellness Resources: Instant access to wellness resources to inspire healthier living.
• Disease Management: Ongoing one-on-one support and motivation for living with diabetes and asthma.
• Healthy Recipes: Tasty and healthy recipes to bring to your table.
• Healthy Pregnancy: Support with pregnancy and new baby support app, as well as breastfeeding classes with a lactation specialist.
• Digital Health Tools and Apps: Find a variety of tools and mobile apps, including popular brand names, to help support your health and wellbeing.

To find out more about our health and wellness programs, call 1-800-720-7253.

• HPN & SHL App: Easily manage your health plan information on the go. Download the app from your app store.
• Online Member Center: Keep track of your health plan information 24/7, including claim history, pharmacy benefits and more.
• 24/7 Virtual Visits: Video chat with a provider for non-life-threatening and non-urgent medical conditions. Same-day medication delivery may also be available (restrictions apply). Download the NowClinic app or visit NowClinic.com.
• Healthy Pregnancy App: Get pregnancy and parenting information on the go, including personalized clinical content for a week-by-week guide. Download the Tummy2Family app.
• Social Media: Connect with us on Facebook and Instagram for healthy lifestyle content and information about your health plan.