Your Medical Benefit
With NHP, you get high-quality coverage and the freedom of choice for your health care needs.
Our provider network gives you access to some of the best doctors, community health centers, medical groups, and leading hospitals all across the state.
We promise you personalized service and a plan that fits your life.
For a full list of medical benefits and member rights and responsibilities, please log in to MyNHP to see all your plan’s specifics.
Your plan covers preventive care—everything you need to stay healthy, including:
- Physical Exams/Check-Ups
NHP covers routine physical exams that are appropriate to your age and sex. Keep in mind, if you need care from any provider, hospital, or clinic, your Primary Care Provider is able to assist you in coordinating these services.
- Flu Shots and other Vaccinations
All are covered at no cost to you.
- Routine Eye Exams.
Routine exams are covered for all members. Frequency limits may apply, so be sure to log in to My NHP and check your plan information. Eyeglasses or contact lenses are not covered through NHP unless you have had cataract or other similar eye surgery.
- Family Planning, OB/GYN and Maternity Care, Prenatal-Postnatal Care
Routine Exams and Maternity Care are covered - no referral is necessary. Some plans may not cover abortion, family planning, or infertility treatment.
Covered Preventive Services Lists
When you need it, medically necessary diagnostic and treatment services are available to you. NHP plans include:
- Specialty Visits
In most cases, specialty visits are covered with a referral from your Primary Care Provider (PCP). It is up to you to make sure that the specialist you wish to see is available and in NHP’s network. You can find a specialist by using our Find a Doctor tool or call NHP Customer Service at 866-414-5533 (TTY 1-800-655-1761).
- Urgent Services (visits due to illness)
Please contact your Primary Care Provider with urgent needs. Your PCP can often see you (or recommend where you can get care urgently). NHP covers urgent care at in-network urgent care centers and walk in treatment centers.
- Emergency Services
If it is an emergency, please call 911 at once or go to the nearest hospital emergency room. Emergency Room Services may have a copay. Log in to My NHP to see your plan’s specifics. In all cases, your Primary Care Provider should be notified within 48 hours of your visit to an Emergency Room (ER).
- Hospital Care
Covered if arranged by your Primary Care Provider.
- Home Health Care
Covered if arranged by your PCP.
- Lab Tests
Preventive laboratory tests have no cost sharing. Tests ordered by your providers are covered, though cost sharing may apply.
- Durable Medical Equipment
DME is equipment that is medically necessary and only has a use in the treatment of illness or management of health conditions. This includes medical supplies, prosthetics, orthotics, and oxygen supplies in addition to equipment like wheelchairs and crutches. DME is covered, though cost sharing may apply. Please log in to MyNHP to check your plan information for coverage details.
Nurse Advice Line
We want you to know about a service that gives you access to a registered nurse, 24 hours a day, 7 days a week. You can call 866-414-5533 (toll-free) or email our Nurse Advice Line (in English or Spanish) about any health concern that you have, large or small. If you email, a nurse will call you back within 24 hours. This service is free for all NHP members.
- There’s no limit on calls or emails. Call (or email) as often as you need.
- NHP covers medically necessary prescription drugs.
- The Nurse Advice Line offers both English- and Spanish-speaking nurses. Also, we will translate for any non-English speaking members at no cost.
- Prerecorded health topics (on many areas of interest and concern) are available. Simply follow the prompts.
- Your call, your health records, and what you discuss with the nurse are all private.
- If you email, a nurse will call you back within 24 hours.
Remember, the Nurse Advice Line does not take the place of your health care provider and you should continue to schedule regular and ongoing visits with your PCP.
If you have an urgent medical need, please contact your Primary Care Provider. If you have an emergency, call 911 at once or go to the nearest hospital Emergency room right away.
Referrals and Authorizations
A Referral is a special permission that is normally given by your Primary Care Provider (PCP) for you to see a Specialist. Examples of Specialists are Cardiologists (heart doctors), Dermatologists (skin doctors), and Allergists (allergy doctor). NHP requires a referral for you to receive care from any NHP In-Plan specialist.
Your PCP must begin the process for obtaining the referral. They can communicate directly with specialists and are required to obtain a referral ID number from us (Neighborhood Health Plan) for these services.
It is up to you to make sure that the specialist you wish to see is available and in NHP’s network. You can find a specialist by using our Find a Doctor tool or call the NHP Member Service Center at 866-414-5533 (TTY 1-800-655-1761).
A Prior Authorization is a special approval by NHP for payment of certain services which you obtain before the service is received. Examples of services requiring Prior Authorization from NHP are some outpatient surgical procedures or planned hospital admissions. When a Prior Authorization is needed, it must be given before you receive the service in order for NHP to cover it. Your PCP or the specialist treating you will request an Authorization if it is necessary.
We at NHP must also authorize your use of any provider who is not part of NHP's Network.