Grand Valley Health Plan - Choose Well
 
 
Home > Member Handbook
 
Member Handbook
 

Dear Member:

Welcome to Grand Valley Health Plan! We are delighted that you have chosen us to provide quality healthcare for both you and your family. Our system is unique; combining integration of both insurance coverage and medical care. It is our goal to provide the highest quality, customer centered, medical attention available because we understand how important that is to you, our members.

As a staff model HMO, we think you will find us less complicated than other plans. There are no claim forms, and most importantly, no mix-ups between the insurance company and the practitioners. Why? Grand Valley Health Plan employs our own family practice physicians and staff so that our members receive direct attention.

As President of Grand Valley Health Plan, it is always a pleasure to welcome new members to our community of care. As a long time member myself, I think that the ability to partner with your health care providers creates a great opportunity to take a proactive approach to prevention and wellness, and to truly build a sound and personal relationship with those who help you with your medical needs.

Again, welcome to Grand Valley Health Plan! You have chosen to join an innovative approach to managing the care of both yourself and your family, and our staff is eager to meet you! You have chosen well.

Sincerely,

Pamela Silva
President, Grand Valley Health Plan


We at Grand Valley Health Plan (GVHP) believe
it is important to share our purpose and beliefs about health care.

Purpose Statement

Grand Valley Health Corporation is a regional health management organization dedicated to providing and managing the services, products and information that our customers value to maintain or optimize their health.

To accomplish this purpose, while providing great performance for our customers, it is essential that we develop and operate an integrated, coordinated health management system, whose culture can "walk the talk" with the following values:

  • Focus on customer value
  • Accept individual accountability for behavior
  • Produce a profitable result
  • Seek effectiveness in outcomes
  • Develop partnering relationships
  • Be creative during change
  • Share team accountability for performance

We believe that:

  • We can influence the qualitative well-being of humans; and that
  • Innovation is the only effective response to change; and that
  • The collective problems of individuals will only be resolved through the collective efforts of individuals; and that
  • The measure of quality is outcomes; and that quantity is important only to the extent that it enhances or facilitates quality and that, there is a better way . . .

Philosophy

GVHP carries out its purpose through a philosophy or belief system that combines the values of cost, quality and service.

GVHP believes in having respectful relationships with our members, practitioners and providers. We believe these relationships should be purposeful. They should be effective, They should result in quality health care and service.

GVHP believes in the value of keeping people healthy. We also believe in making them well. Prevention is the key. Programs and services that lower the risks of disease and illness are at the "heart" of what we do at GVHP.

GVHP believes in the value of quality. We do this by credentialing our health care professionals. Credentialing is a review process health care professionals undergo. We look at their “credentials.” This process is hard and complete. We hold these professionals to high standards. We measure quality of care and customer satisfaction.

GVHP believes in quality-based health care. We believe in cost-effective health care. We do this by contracting with selected health care practitioners and providers. Our contracts address quality and service as well as cost.

GVHP believes in keeping our members informed. We want you to have information about how our health plan works. We want you to know how our physicians and health care providers are paid. We want you know how resources are used and managed. This is called utilization management. Finally, we want you to know how these show and support quality of care.

GVHP believes that members have the right to voice complaints. You also have the right to appeal GVHP decisions. Finally, you have the right to expect timely service and responses.


How To Use This Handbook and General Plan Information

This is your Grand Valley Health Plan Member Handbook. The information contained in this booklet will explain how GVHP works. Please review the information and keep it handy for future reference. On behalf of the Grand Valley Health Plan team, we look forward to serving your health care needs!

This handbook was designed to help guide you through the Grand Valley Health Plan system. Please take time to review it carefully. Make sure both you and your family understand your benefits before a time arises when you may need to use them. Keep this handbook in an easily accessed place, along with your GVHP Provider Directory and GCHP Certificate of Coverage. The GVHP Provider Directory lists all GVHP Family Practice Office locations, practitioners (GVHP physicians, nurse practitioners and physician assistants) and additional services offered by Grand Valley Health Plan.

The Provider Directory and your Member Handbook contain information that you need to know about Grand Valley Health Plan. That information includes:

  • The scope of our services
  • Our practitioners
  • Your benefits
  • Your coverage
  • Your rights and responsibilities

Please make sure that you have the most current version of these documents to assist you in making your healthcare decisions. Please take time to review and understand these important benefit documents. If you have any questions or need an additional copy of this information, please contact Customer Service at the number listed in the next section or download a copy of the Handbook from our website.

Questions Regarding Coverage

Grand Valley Health Plan is continually seeking to improve the service we give you, our members. The Customer Service Team is always willing to answer your healthcare benefit questions.

If you have a medical question about your healthcare, you should call your GVHP Family Practice Office or GVHP Practitioner. Our Customer Service Representatives are also available to answer any benefit questions you may have.

Customer Service Hours
Monday - Friday 8:30a.m. - 5:00 p.m. EST
Extended evening hours (September - February)
Customer Service phone numbers
Customer Service Department (616) 949-2410 or
(800) 335-1977
Collect telephone calls are also accepted at all GVHP locations.

Help for Members who are Hearing or Speech Impaired,
or Speak a Language other than English.

Grand Valley Health Plan can help you communicate with our staff if you are experiencing difficulty in doing so. We believe that assuring good communication can improve a member’s medical visit. While many of our members prefer to bring in or have someone they are familiar with to assist them in communicating, GVHP can also make arrangements for a translator, when notified in advance of a Members appointment time at a GVHP Family Practice Office. Please contact your individual GVHP Family Practice Office if this service is required.

In order to best serve the needs of our member community, Grand Valley Health Plan also offers translation services via the AT&T Language Line. The AT&T Language Line affords the GVHP Family Practice Office a unique opportunity to obtain and maintain solid relationships with our members.

Important Tips and Hints About Your Coverage

  • It is important to carry your Grand Valley Health Plan Member ID Card with you at all times. Plan to present it at your GVHP Family Practice Office, referral appointment, hospital, or other facilities.
  • Whenever you need medical care, day or night, call your GVHP Family Practice Office first our phones are answered 24 hours a day. Unless you have an emergency condition, your GVHP Family Practice Provider must arrange all of your healthcare. Our phones are answered 24 hours a day.
  • If your practitioner decides that you need specialty care, he or she will refer you to a Grand Valley Health Plan participating specialist who uses GVHP participating hospitals.
  • If you have an emergency condition and there is no time to contact your GVHP Family Practice Office, go to the nearest emergency room, or call 911.
  • If you were unable to contact your GVHP Family Practice Office before obtaining emergency care, please call your GHVP Family Practice Office within 24 to 72 hours, so that your follow-up care can be arranged.
  • Unless you have an emergency condition, Grand Valley Health Plan will only pay for care and services if the three following conditions are met:
    1. Care and services are arranged and authorized by a provider at your GVHP Family Practice Office.
    2. Care and services are provided by participating physicians and health care facilities.
    3. Care and services are covered by Grand Valley Health Plan as described in your Certificate of Coverage.