Sentry Page Protection

Activity 

Network Information

Understanding Your Network Is Important

+ Add My Current Primary Care Provider , Last Name , First Name , PCP ID , Address

+ Add Specialist , Last Name , First Name , PCP ID , Address

Select the correct answer A or B : I need to get my care and services from 

A . network providers , But if I need emergency care , urgent care or out of area dialysis , it will be covered whenever I need it.

B.  out of network providers , But if I need emergency care , urgent care or out of area dialysis , it will be covered whenever I need it.

HMO = My Plan is available only in the Plans Service area which is _________________________________. If I move outside of this Service Area for more than six months in a row , I will need to choose a new plan. I will ask my Licensed Sales Representative or Customer Service to help me. Your plan is a Health Maintenance Organization (HMO) plan. That means you must receive care through a network of local doctors and local hospitals. Your Primary Care Provider (PCP) oversees your care. 

HMO-POS

LPPO

RPPO

PFFS

SelfPay

Does Your Plan Type Require Referrals ? Yes or No

Please know the name of your primary care provider PCP. You must select a primary care provider (PCP). This health plan requires you to select a PCP from the Network who can help Manage Your care.

Please know the name of your Clinic

Please Know the name of your Health Center .

Please Know the Name of Your Specialists .There is no need to get a Referral to see a Specialist. You can see any specialist in our Network . If you don't use the Network , in most cases , you will have to pay for all of the costs.

You can find a list on the plan website or in the current Provider Directory

Provider PCP Full Name

Phone Number

Provider PCP ID Number

Are you now seeing this doctor?

Have you recently seen this doctor?

Stay in the Network

                                                                                  In Network                               Out of Network

Will the doctor accept my plan?                                       y                                           n

will the hospital accept my plan?                                    y                                               n

Are urgently needed services covered?                         y                                               y

Are emergency services covered?                                  y                                                y

do i have to pay the full cost for 

       all covered doctor services?                              copay or coinsurance              in most cases yes you must pay the full costs

do i have to pay the full cost for

      all hospital services ?                                           copay or coinsurance              in most cases yes you must pay the full costs