Your HEALTHmatters

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.