Your Member Handbook describes your benefits and how to use them. Other information available in the Member Handbook includes:
Benefits, services and covered medicines
- Services/medicines your health plan covers and doesn’t cover.
- Copays (if needed).
- Submitting claims for covered benefits (if needed).
- Your rights and responsibilities as an HPSM member.
Providers
- Selecting a primary care provider (PCP).
- Details about both in- and out-of-network care.
- Finding information about network providers (PCPs, specialty and mental health providers, and hospitals).
Access to care, such as getting:
- Care where and when you need it (in an emergency, after normal business hours or when outside San Mateo County).
- Health care services and prescription medicines.
- Information and services in your preferred language.
Appeals and complaints
- Submitting an appeal for a denied service.
- Details about HPSM’s appeals review process.
- Submitting complaints.
- How decisions are made to cover new technology as a benefit.
The Member Handbook is updated regularly. See the latest version.