Primary Choice lets you access care from a network of medical professionals. The key is your primary care physician. He or she is responsible for providing or coordinating all your health care. Your primary care physician is available to you 24 hours a day, seven days a week! If your doctor isn't available, another doctor will cover for him or her.
When you need services from a doctor other than your primary care physician, he or she will refer you to a specialist who participates in our network. You'll get an authorization that states what services we will cover according to your plan benefits. Using network participants saves time and effort.
- File claims for covered expenses for you.
- Ask you to only pay the copayment, deductible and coinsurance amounts, if any, for covered expenses.
- Accept our payment as payment in full for covered expenses, minus the out-of-pocket expense, if any.
Primary Choice covers medically necessary services we list in the contract we sign with each employer.
While each contract may be different, most cover these services for just a small copayment or coinsurance amount:
- Physician and hospital services
- Urgent and emergency care
- Prescription drugs at low copayments
- Mental health and substance abuse treatment
- Physical, speech and occupational therapy
- Ambulance service
- Dental services needed for accidental injury
- Durable medical equipment, supplies and original prosthetic appliances
- Home health and hospice care
- Routine vision and dental care
To see exactly what we cover, please check your schedule of benefits. You can also see our Member Guide. For more information, please call our Marketing department at 800-327-3183.
You can also view a sample Summary of Benefits and Coverage and a sample certificate of coverage.