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Medical Policies

Using Clinical Coverage Criteria to Determine Medically Necessary Covered Care.

NHP medical policies, or clinical coverage criteria, help us evaluate the safety and effectiveness of a service or technology to determine if it should be covered. We base our medical policies on objective, reliable resources such as:

  • Guidelines from nationally recognized health care organizations
  • Peer-reviewed medical journals
  • Reports from professional organizations and government agencies
  • Expert opinions from health care professionals
  • Evidence-based consensus statements

We review all of our medical policies at least once a year, and we make updates whenever it's appropriate.

To see the medical policy or clinical coverage criteria for a specific condition, simply click a link below*. The documents outline coverage criteria for all NHP members. However, the NHP medical policies will not tell you whether a service or technology is covered under your plan.

For more information about our medical policies or about your plan, please call the Customer Service number on the back of your member ID card or email memberservices@nhp.org.

Log into MyNHP.org to find personalized information about your covered benefits.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

*Please note that these Clinical Criteria are not intended to certify coverage availability.