Know your coverage when you’re out of town.
The Health Plan only provides coverage for emergency care when you are outside your immediate hometown area.
Emergency Care can be defined as “medical and health services provided in cases of life-threatening, disabling, or serious illness or injury, including severe pain which arises or worsens suddenly and which, if not treated immediately, could result in loss of life or permanent damage to a person’s health.”
Routine Care, which is NOT covered outside your hometown area, includes such services as physical examinations, sports physicals, immunizations, routine eye exams.
Minor medical problems require pre-approval of coverage, such as an office visit for a sore throat or earache. We recommend that you call ahead when possible to let us determine coverage and help you locate the appropriate source of care for your problems. Our Patient Services/HELP Nurses are available 24 hours.
- Always carry your Health Plans Identification Card when you travel, and present it whenever medical care is sought.
- Call the toll-free number on the back of your card before seeking medical care, if possible. If not, have a relative call for you.
- Our Health Care Services nurses must be notified within 48 hours after an emergency hospital admission out of the area. They will communicate with the hospital and doctor to confirm your coverage and determine the most appropriate timeframe for the transfer of medical care back home.
- If you experience a minor medical problem that may require attention before you return home, please do not hesitate to call the Health Care Services nurses. With the proper pre-approval from the Health Plans, coverage can be granted on a limited basis, and any necessary medical follow-up provided back home.
- Receipts for pre-approved services you’ve paid for or billings you’ve received should be forwarded to us for review and handling. Reimbursement for approved care out of the area is made based on your contract stipulations such as copays, deductibles, and usual/customary allowables.
Health Care Services: 563-584-4885 or 1-866-821-1365
You can fill a prescription when you’re out of town.
If you need a prescription filled when out of the service area (vacation, traveling, school, etc):
- Please utilize a national pharmacy chain whenever possible.
- Have your MAHP Identification card with you and present to the pharmacist.
- A prescription will not process if written by a physician/provider who is not in our participating list of providers. An authorization will need to be entered into our information system prior to the prescription being processed. If a prescription is written by a non-participating physician, please contact the Health Care Services staff at 563-584-4885 or 1-866-821-1365. You may also notify the Patient Services department after hours and they will notify Health Care Services the next business day.
If your prescription does NOT process, you have several options:
- Contact Pharmacy Services at 563-584-4885 or toll free at 866-821-1365 and staff will assist you and the pharmacy in the processing of your prescription, or
- Pay for the prescription in full and send the prescription receipt to:
Medical Associates Health Plans
1605 Associates Drive, Suite 101
Dubuque, IA 52002
Attn: Pharmacy (This address is listed on the back of your MAHP Identification Card) or
- Ask the pharmacist to fill the prescription and to process it the next business day. You would remain responsible for the applicable copay.
