HEALTH AND WELLNESS 23 You can choose a different PCP and/or PMG for each covered family member. Information about whether the provider is accepting new patients is displayed when making PCP elections. A provider who is not accepting new patients appears as "not accepting new patients." If you are an existing patient of this provider, you may elect the provider as your PCP even if their panel status is "not accepting new patients." You can change your PCP at any time by calling Scripps Health Plan Customer Service at 844-337-3700. If you are a continuing HMO member, please call Customer Service to make any PCP changes rather than making the change during Open Enrollment. Your PCP change will be effective the first of the month following your call or sooner depending on certain criteria. Your PCP will provide the appropriate services or referrals to other plan providers within your PMG. If you need to see a specialist, you will need a referral from your PCP for the services to be covered. You will have direct access to certain services such as annual mammogram screenings, OBGYN care within your PMG, and other routine services that may not require a referral from your PCP. In the rare circumstance where you require specialty care that is unavailable through your PMG, authorization would be required for services to be provided outside of the PMG. With the HMO option you have no calendar year deductible, no claims to file, and pay a fixed copay for most covered services. Exclusive Provider Organization (EPO) Option The EPO option provides quality care through the Scripps Custom Network. All medical care must be provided by a Scripps Custom Network provider except in the case of an emergency. You must designate a primary care physician (PCP) for yourself and each covered family member when you enroll to ensure the lowest office visit copay ($30 copay vs. $40 copay). You may change your PCP at any time at https://benefits.scripps.org. Care can be coordinated by your PCP or you may self-refer to any provider within the Scripps Custom Network. Visit MyScrippsHealthPlan.com to find a PCP and other network providers. Eligible employees who live and work outside of San Diego County and eligible covered dependent(s) living outside of San Diego County may be eligible to enroll in the Outof-Area Plan. Care must be provided by the contracted national provider network to receive benefits under the EPO option. Eligibility for each covered member will be determined at time of enrollment based on the address submitted online at https://benefits.scripps.org. If any of your covered members move during the year, it is your responsibility to submit the updated address in the benefits web enrollment system for placement on the Out-of-Area Plan. If an address is not provided, claims for providers outside of the Scripps Custom Network will not be covered.
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