Covered Benefits
Primary Care
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. Part of the plan enrollment process includes linking members to a PCP. Members can select 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:
- Annual physical exams and preventive screenings
- Sick visits or checkups
- Prescriptions
- Immunizations (shots)
- Referral to a specialist
Specialty Care
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 provider without a referral or authorization and/or who is not a Polk HealthCare Plan Provider, you will be responsible for all costs associated with that care.
Specialty Care visits are limited. Please refer to the copay chart below.
Behavioral Health Care
If you have a mental health concern or substance use issue, behavioral healthcare 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.
Urgent Care
If you are experiencing a non-life threatening emergency, e.g., broken bone, hives, etc., or you cannot get an appointment with your PCP and need to see a medical professional, go to a participating urgent care center.
Emergency Care
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 in an urgent care setting.
Find A ProviderFitness Membership (YMCA)
In the realm of healthcare, there is much to be said about prevention and its link to physical activity. Physical activity refers to all movement – walking, running, swimming, yoga, strength training, cycling, organized sports, and recreation. One of the most important things you can do to prevent disease and fend off bad health is to become more physically active.
Because physical activity plays a fundamental role in health and wellness, PHP has teamed up with the YMCA of West Central Florida. PHP members now have access to a YMCA membership at two YMCA locations in Lakeland. Present your Polk HealthCare Plan membership card for YMCA membership enrollment.
YMCA membership includes access to the following services: wellness area, gymnasium, racquetball courts, group exercise, Coach Connect and pools.
Copays
| Essential Care Choice Service and Description | In-Network Provider | Plan Year Benefit Limit(s) |
|---|---|---|
| Preventive/Annual Screenings | $0 | 1 visit/test per plan year for: Pap smear, colonoscopy, prostate exam, routine annual exam |
| Primary Care Physician* Regular office visit/sick visit | $1 copay | *Primary Care Physicians (PCP) are family providers, internal medicine providers, and general practitioners. Note: Services rendered by PCP, not assigned to the member, will not be covered |
| Urgent Medical Care | $0 | No limit |
| Emergency Room | $25 copay | $1,500 annual cap per member; emergent condition required to demonstrate medical necessity |
| Hospital Care-Inpatient | $0 | 6 days per admission and up to 30 days per plan year |
| Hospital Care - Outpatient | $25 copay | Limited to 24 hours |
| Physical Therapy - Outpatient | $5 copay | 36 visits |
| Chronic Care Choice Service and Description | In-Network Provider | Plan Year Benefit Limit(s) |
|---|---|---|
| Preventive/Annual Screenings | $0 | 1 visit/test per plan year for: Pap smear, colonoscopy, prostate exam, routine annual exam |
| Primary Care Physician* Regular office visit/sick visit | $1 copay | *Primary Care Physicians (PCP) are family providers, internal medicine providers, and general practitioners. Note: Services rendered by PCP, not assigned to the member, will not be covered |
| Urgent Medical Care | $0 | No limit |
| Emergency Room | $25 copay | $1,500 annual cap per member; emergent condition required to demonstrate medical necessity |
| Hospital Care-Inpatient | $0 | 6 days per admission and up to 30 days per plan year |
| Hospital Care - Outpatient | $25 copay | Limited to 24 hours |
| Physical Therapy - Outpatient | $3 copay | 36 visits |
Find a Provider
The list below features, primary care providers, participating laboratory locations, urgent care centers and emergency departments. If you require a specialty care provider, please contact your primary care provider for a referral.
| Provider | Group/Organization | Area of Care | Provider Type | Location | Contact |
|---|
Resources
Find more information on Polk County health services, access Polk HealthCare member documents and download to learn more about what’s new with the plan and health coverage.
Find us in the Community
Whether you want to speak with a Polk HealthCare Plan representative to learn more about the plan, take advantage of free health screenings, attend an outreach event or view upcoming diabetes management and healthy living classes, find us in your community.
Eligibility & Requirements
To qualify for membership in the Polk HealthCare Plan, you must meet the residential and income requirements.
Learn MorePlan Rights & privacy
Knowing your responsibilities and rights are important. Health Insurance Portability and Accountability Act of 1996 (HIPAA), gives you rights over your health information, including the right to get a copy of your information, make sure it is correct and know who has seen it.
Learn More