Health Center/PCP

Health center/PCP

A health center refers to the network in which members of Health Plan Hawaii receive medical care. The health center also serves as the contracting entity for physicians participating with Health Plan Hawaii and HMSA’s other HMO plans.

Changing a health center

Health Plan Hawaii allows members to change their health center. The member’s employer usually requests the change during the open enrollment period. Typical reasons for requesting a different health center include a change in residence or employment.

The member may request a change of health center outside of the open enrollment period by contacting HMSA’s Customer Service Department at 808-948-6372. In these circumstances, requests that might affect a member’s continuity of care are subject to review. HMSA may postpone the request if:

• The member is an inpatient in a hospital, skilled nursing facility, or other medical institution at the time of the request;
• The change could have an adverse effect on the quality of the member’s healthcare;
• The member is an organ transplant candidate; or
• The member has an unstable, acute condition for which he/she is receiving active medical care.

Changing a PCP

While Health Plan Hawaii emphasizes the importance of one Personal Care Physician (PCP) managing a patient’s care, circumstances may arise that interfere with this relationship. For example, conditions that existed at the time of the PCP selection may have altered, affecting the member’s original decision. Members of Health Plan Hawaii can change to a PCP within their existing health center or from a different health center.

Limited panel

Occasionally, the practitioner may need to limit his or her panel to established patients (someone who received professional services from the practitioner within the past three years) to optimize care. In these instances, the practitioner must notify HMSA of the change in writing. This information will be reflected in subsequent HMSA provider directories for new members.

Effective dates

The effective date for an approved health center or PCP change is based on the date the request was received, as follows:

• Requests received between the first and the fifth of the month can be effective on either the first of the current month or the first of the following month. The member will be asked to select between the two options.
• Requests received from the sixth through the 31st of the month will be effective on the first of the following month.

Note: Changes made during the open enrollment period are effective in accordance with the employer’s renewal date.

Revision History