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Coverage criteria policies

HealthPartners has Medical Policies that contain coverage criteria that describe how we make coverage decisions for certain health care services and items. Which coverage criteria apply to your plan depends upon the state in which the plan was purchased, which is not necessarily your state of residence. For a customized experience, log on to myHealthPartners. For questions, call the Member Services number on the back of your member identification card.

The information regarding coverage guidelines is regularly updated and is subject to change without notice. Read more…

Medicare plans

For Medicare coverage criteria, click here.

For a list of services requiring Medicare prior authorization, click here.

If unsure of the keyword spelling, enter the first three letters of the word followed by an asterisk (*). Example: enter acu* to locate the acupuncture policy.

Policy search filters

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Viewing 10 of 325 policies
Policy name Policy category Product Prior authorization required
Ocrelizumab (Ocrevus) Pharmacy
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Ocrelizumab (Ocrevus) - Minnesota Health Care Programs Pharmacy
MHCP
Yes
Omalizumab (Xolair®) Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Oncology drug coverage Pharmacy
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Oral appliances for sleep disorders Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
Yes
Oral appliances for sleep disorders – Minnesota Health Care Programs Equipment/Supplies
MHCP
Yes
Orthotics / braces / shoes Equipment/Supplies
Iowa
Minnesota
North Dakota
South Dakota
Wisconsin
No
Orthotics / braces / shoes – Minnesota Health Care Programs Equipment/Supplies
MHCP
No
Outdoor behavioral health programs Behavioral Health
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
Oxygen Equipment/Supplies
Iowa
MHCP
Minnesota
North Dakota
South Dakota
Wisconsin
No
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Viewing 10 of 325 policies