- You choose a primary care physician from the plan's list who coordinates all your care.
- You need a referral from your primary care physician to see other doctors in the plan network. For more information, see How do referrals work in my HMO plan?
- In an emergency, go to the nearest doctor or hospital. Eligible services are covered in Michigan, the U.S. and abroad.
- If you go to a doctor or hospital without a referral or outside the plan network in Michigan for non-emergency care, you'll pay the entire cost. Always ask your primary care physician for help coordinating your care.
Who qualifies as a primary care physician?
- Family and general practice doctors who treat patients of all ages and provide obstetric and gynecologic care.
- Preventive medicine doctors who promote health and well being for patients of all ages.
- Internal medicine doctors who identify and treat illnesses in adolescent, adult and geriatric patients. Most patients are 18 and older.
- Internal medicine and pediatric doctors who identify and treat illnesses in infants, children, adolescents and adults.
- Pediatricians who treat infants, children and adolescents under age 18.
If you don't get a referral from your primary care physician to see a specialist in another area, such as a dermatologist, you'll have to pay for the entire cost of the service.