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Physicians Health Plan of South Michigan will be transitioning its membership to Priority Health, subject to regulatory approval.

Learn more about Priority Health

Physicians Health Plan of South Michigan Named One of the Best in The Nation by U.S.News & World Report/NCQA “America’s Best Health Plans” 2006

For the second year in a row, Physicians Health Plan of South Michigan has been named one of the best commercial health plans in the nation by the U.S.News & World Report/NCQA "America's Best Health Plan"* 2006.

iSave

PHPSM is proud to offer you iSave - our six new high deductible health plans (HDHP's). iSave features low premiums and first dollar coverage for preventive care. iSave helps you get your healthcare spending back on track. For more information, please click the title link above.

Leapfrog

Leapfrog is a program to provide information about health care safety, quality and customer value. Click the title above for more details.

Member Rights and Responsiblities

Member Rights
Enrollment with Physicians Health Plan of South Michigan (PHPSM) entitles you to:
  1. Be given information about your rights and responsibilities as a member.
  2. Be treated with respect, consideration and dignity.
  3. Information about all available health services, including a clear explanation of how to obtain them.
  4. Services as covered by PHPSM, provided that these services are from participating physicians, practitioners or other providers.
  5. Expect that your medical records and communications will be treated in a confidential manner, as required by law.
  6. The choice of a Primary Care physician or provider (PCP) from a list of participating physicians or practitioners.
  7. Full information on the nature and consequence of any treatment, test, or procedure that may be involved in your healthcare, regardless of cost or benefit coverage.
  8. The opportunity to participate in decisions involving your healthcare, make decisions to accept or refuse medical or surgical treatment, and be given information on the consequences of refusing or not complying with treatment.
  9. Refuse to participate in experimental research.
  10. The use of the PHPSM’s complaint/grievance procedure to resolve problems.
  11. Choices on "Advance Directives." "Advance Directives" is a term used to describe a plan for medical treatment you wish to have followed in case you are in a situation where you are unable to express your wishes. Your decision regarding this treatment is made in advance or before the situation occurs.
  12. Be given information about PHPSM, its services, and participating providers and practitioners who provide health services.
  13. Voice complaints or appeals about PHPSM or the care provided.
  14. Make suggestions regarding PHPSM member rights and responsibilities.
Member Responsibilities
All PHPSM enrollees are responsible for understanding the following:
  1. You must select a Primary Care Provider from PHPSM’s list of participating providers.
  2. All medical care, except in emergencies, must be obtained from a participating provider. All visits to non-participating providers must be approved in advance by PHPSM.
  3. All hospitalizations must be approved by PHPSM and arranged by your PCP or participating specialist, except in emergencies or for urgently needed health services.
  4. Emergency room services may be used only for treatment of a serious medical condition resulting from injury, sickness or mental illness, which arises suddenly and requires immediate care and treatment (generally within 24 hours of onset) to avoid jeopardy to your life or health.
  5. You must schedule appointments with your PCP as far in advance as possible and call if you are unable to keep an appointment.
  6. You must always carry your PHPSM ID card, present it to the provider each time you receive health services, and never permit its use by another person.
  7. You must call the Customer Service Department if you have a question about your PHPSM coverage.
  8. You must notify PHPSM of any changes in address, changes in eligible family members, and changes of marital status, or if you acquire other health insurance coverage.
  9. You must provide complete and accurate information concerning your health and healthcare to physicians, practitioners and providers and to PHPSM to make sure that services are not repeated and are medically necessary.
  10. You must participate in understanding your health problems and developing treatment goals you agree on with your PHPSM provider.
  11. You must follow the plans and instructions for care that you agree on with your PHPSM provider.
  12. You must pay all applicable copays directly to the participating physician, practitioner, or provider that gives you care.
If you have questions or would like a copy of this document mailed to you, please contact our Customer Service Department at 517-787-6865 or 1-800-394-7569.