New Rule – Everyone must have PCP Primary Care Physician even if you have an PPO
Covered California health plans and as near as I can tell, all plans – see the Insurance Company bulletins and brochures, are required as of 1.1.2017 to ensure that ALL Covered California members either select a Primary Care Physician (PCP) or have one recommended by their health plan.
Health plans will make a recommendation by January 1, 2017 or within 60 days of the consumer’s effective date with the health plan. If the health plan selects the PCP, consumers will be able to change to another physician at any time.
View actual Evidence of Coverage page 14 and check out the definitions and explanations of the role of the PCP Primary Care Physician and IPA Independent Practise Assoc.
Blue Shield Memo
In 2017, we will be selecting a primary care physician (PCP) for you so you can begin building a relationship with your doctor.
Having a PCP means you have a doctor you can turn to for healthcare advice—whether it’s preventive care, treating common illnesses and injuries, or helping you determine if you need specialized care.
Flexibility with a PPO plan
As a PPO member, you have the flexibility to see any doctor you want, in or outside the network. Just remember that you will get the best value if you select a PCP that participates in Blue Shield’s Exclusive PPO Network.
In addition, many preventive care services such as routine physical exams, screenings and vaccinations are covered 100% under your plan when you visit a PCP in your plan’s network.
In early 2017, we will send you your PCP information, including instructions on how to view or change your PCP online if you’d like to do so.