Medical Services Not Requiring Referral

You may get the following services on your own, without a referral (approval in advance) from your PCP. You still have to pay your share of the cost, as appropriate, for these services.

• Routine women’s health care, which include breast exams, mammograms (x-rays of the breast), Pap tests, and pelvic exams. This care is covered without a referral from a plan provider.
• Flu shots and pneumonia vaccinations.
• Emergency services, whether you get these services from plan providers or non-plan providers.
• Urgently needed care that you get from non-plan providers when you are temporarily outside the Plan’s service area. Also, urgently needed care that you get from non-plan providers when you are in the service area but, because of unusual or extraordinary circumstances, the Plan providers are temporarily unavailable or inaccessible.
• Dialysis (kidney) services that you can get when you are temporarily outside the Plan’s service area. If possible, please let us know before you leave the service area where you are going to be so we can help arrange for you to have maintenance dialysis while outside the service area.

You may get care when you are outside the service area. You will usually pay higher costs for the care because you will get your care from non-plan providers, but you will not pay extra if you are getting care for a medical emergency. If you have questions about your medical costs when you travel, please call Customer Service.