Common use of Choice of Providers Clause in Contracts

Choice of Providers. The Plan has established a network of primary care and specialty Physicians, Hospitals, Participating Hospice Agencies, and Non-Physician Health Care Practitioners to provide Covered Services to Members. A Member must obtain or receive approval for all Covered Services from his Primary Care Physician. Each Subscriber must select a Primary Care Physician for himself and each of his Dependents from the list of Primary Care Physicians in the Trio HMO Health Plan Physician and Hospital Directory. Members enrolled in this Trio HMO Health Plan may only obtain Covered Services from Primary Care Physicians and Medical Group/IPAs designated as Plan Providers in the Blue Shield Trio HMO Health Plan Physician and Hospital Directory, except for Emergency Services or Urgent Services when the Member is out of the Service Area. The Physician and Hospital Directory applicable to this Plan will be given to Members at the time of enrollment. A Member’s Primary Care Physician will be accessible to the Member on a 24-hour-a-day, 7-day-a-week basis, or will make appropriate arrangements to assure coverage. Emergency Services will be provided on a 24-hour-a- day, 7-day-a-week basis by a Plan Hospitals.