Getting Care

Choosing a PCP

A family doctor (also called a primary care providerYour family doctor you see for most of your healthcare needs. or PCP) knows you and your medical history. Find out more about why a PCP is an important part of your health journey.

Choose a PCP

Virtual Health

For nonemergencies, state-licensed, board-certified physicians (including pediatricians) are available online – around the clock and around the world. When you can’t get to the doctor, expert healthcare is available from anywhere – 24/7/365.

Stay in network

A common (and costly) mistake people make is visiting doctors or other healthcare providers who are not in their insurance company's networkA group of doctors, hospitals and other professionals who have been contracted to provide medical services to members..

Prior approval

Sometimes prior approvalApproval from your health plan before you receive certain tests, procedures or medications. The health insurance company reviews the care plan to determine if it is medically necessary and appropriate for your situation. is needed to protect your health. Other times it may be needed to protect you from expensive tests or treatments when there are other, less expensive options available. Find out which services might require prior approval.

Total Care

Total Care recognizes doctors that focus on health care instead of sick care. Total Care is coordinated, patient-focused and, in many cases, more affordable healthcare.

Blue Distinction Centers

Find out which hospitals demonstrate superior capabilities in specialty care procedures, such as bariatric surgery, cardiac care, hip replacement and more.

Value-based care programs

Value-based care initiatives reward physicians for positive health outcomes and coordinating care. Find out more about programs like Patient-Centered Medical Homes (PCMH) or the Comprehensive Primary Care initiative (CPC, CPC+) and other programs using the value-based care model.

InterQual^® Coverage Policy Guidelines

The InterQual^® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.
Please consult your provider for applicable policies and/or criteria.