Polk HealthCare Plan
The Polk HealthCare Plan offers Polk residents access to healthcare. The plan is not insurance and members do not pay annual deductibles, monthly fees, enrollment fees or submit claim forms. Members only pay small co-pays for doctor visits or filled prescriptions.
The Polk HealthCare Plan partners with licensed medical providers in the community to connect Polk residents with the care they need.
Covered Benefits Overview
A primary care provider is a healthcare professional who practices general medicine. A PCP can be a doctor, an advance practice registered nurse or a physician assistant. Prior to enrollment completion members choose or are assigned a primary care provider based on their preferences and needs.
Your Primary Care Provider’s office will be the place where you receive most of your medical care. Your PCP will be your go to provider for the following:
- Annual physical exams and preventive screenings
- Sick visits or check-ups as needed
- Immunizations (shots)
- Referral to a specialist
If you have a specific health issue, condition, injury or disease you may need to see a specialist. If necessary, your primary care provider will refer you to one for care.
You must receive specialty care from a provider contracted with the Polk HealthCare Plan. If you receive care from a specialty care physician without a referral or authorization and/or who is out of the PHP provider network, you will be responsible for all costs associated with that care.
Specialty Care visits are limited. Please verify with customer services or refer to the copay chart for limits.
Behavioral Health Care
If you have a mental health concern or substance use issue, behavioral health care providers can assist you. You do not need a referral from your PCP to see a mental health or substance abuse provider. The benefit covers a variety of services, evaluations, assessments, therapies (individual, family, group, etc.), counseling, psychiatric support and medication management.
If you are experiencing a non-life-threatening emergency (ex: broken bone, hives, etc.) or you cannot get an appointment with your PCP and need to see a medical professional, you should go to a participating urgent care center.
The Polk HealthCare Plan defines emergency care as treatment for potential life-threatening or limb threatening complications, which means that you believe that you could die or lose a limb, e.g. arm, hand, leg, etc. and that the treatment you need cannot be given in your PCP’s office or an urgent care setting.