FREQUENTLY ASKED QUESTIONS

Yes, CNS HealthChoice members will need to choose a primary care physician. You have the right to designate any primary care provider who participates in the network of CNS HealthChoice.  If you do not select a primary care physician, one will be selected for you. Please review your HealthChoice Program Handbook for further details.

Yes, please refer to your HealthChoice Program Handbook for details on copay and/or deductibles for covered services.

Covered Services means the Basic Covered Services to which a Member is entitled as set forth in Section 10.03 of this Subscriber Certificate, and any Supplemental Covered Services specified for the Subscriber in the Subscriber Application, when provided under the terms of this Subscriber Certificate.

Covered services include:

  • Physician Services / Office Visits
  • Inpatient Hospital Services
  • Outpatient Hospital Services
  • Urgent Care Facility Services
  • Emergency Health Services
  • Mental Health Services
  • Substance Abuse Services
  • Prescription Drug Service
  • Radiology
  • Contraceptives
  • Mastectomies and Lumpectomies
  • Physical Therapy
  • Durable Medical Equipment
  • Preventative Care
  • Diagnostic Evaluation

 

For more information, please review your HealthChoice Program Handbook for detailed information.

Your Primary Care Physician will refer you to an in-network specialist.

We value our members and will work to provide solutions for the members. For further information on rights and responsibilities, please review your HealthChoice Program Handbook.

We understand health coverage and benefits, and cost savings are important for your business and will work to provide solutions for you.  For further information on the rights and responsibilities of employers, please HealthChoice Program Handbook.

Remember to carry your HealthChoice Identification Card with you. In case of emergency, please follow the instructions on the back of your Identification Card. Please refer to your HealthChoice Program Handbook for more details.

Under the Affordable Care Act, dependents can be covered until age 26. For more information please review your HealthChoice Program Handbook.

In some circumstances, the law allows us to use or disclose your Protected Health Information without asking for your authorization in advance or giving you an opportunity to object. These circumstances include:

  • For Payment
  • For Treatment
  • For Health Care Operations
  • As Required by Law
  • Public Health Risk
  • Health Oversight Activities
  • Medical Examiners and Funeral Directors
  • To Avert a Serious Threat to Health or Safety
  • For Health-Related Benefits or Services
  • Specific Government Functions
  • Individuals Involved in You Care or Payment for Your Care
  • Organ and Tissue Donation
  • Workers’ Compensation
  • Inmates
  • To the Federal Department of Health and Human Services (DHHS)
  • To Our Business Associates

For detailed information on confidentiality and the sharing of PHI please refer to your HealthChoice Program Handbook.

We value our members and will work to provide solutions for the members. For further information on rights and responsibilities, please review your HealthChoice Program Handbook.

If individuals are eligible for other medical coverage including Medicaid and Medicare, they are ineligible for HealthChoice of Michigan.

Unless terminated sooner pursuant to the provisions of either Section 12.02 of your member handbook or the Group Operating Agreement, the term of this Subscriber Certificate shall be to the December 31st following the effective date hereof, and thereafter shall automatically renew for successive terms of one year each. Subject to rights of continuation specified in Part XIII, this Subscriber Certificate may be terminated by the Program in events described in detail in your HealthChoice Program Handbook.