Additional information about your policy:

What is a Primary Care Physician?

If you are in a managed care program such as Blue Care, you must select a Primary Care Physician for each of your family members. Your entire family may use the same physician or each family member may choose his or her own. It is important that you are comfortable with your selection, since your Primary Care Physician manages your care. Think of the relationship as a partnership between you and your physician. Also know that when our members use Primary Care Physicians for most of their health care, we can keep costs down for everyone.

If you do not have a managed care plan (for instance, if you have Catamount, Plan J, Comprehensive or the Vermont Freedom Plan) you do not have to choose a primary care physician. We do encourage you, though, to develop a relationship with one doctor who can help coordinate your care.

Choosing Your Primary Care Physician:

The online directory provides a list of providers who are Primary Care Physicians. Physicians are listed by the county in which they practice. To narrow your search for Primary Care Physicians who have contracted with your plan, choose the appropriate Network on the provider search screen (e.g., Blue Care - The Vermont Health Plan or Vermont Health Partnership).

Many medical practices have nurse practitioners and physician assistants as part of their health care teams. One of these licensed health care professionals may provide services to you when you select a Primary Care Physician with whom he or she practices. You must select a Primary Care Physician even if you prefer to see the nurse practitioner or physician assistant affiliated with that physician most often.

When you fill out your application for BlueCare, select a physician from the directory and put his or her name and provider number on the form. Please note that you must select a Primary Care Physician for each of your family members. Otherwise, your health care benefits may be seriously restricted. If you would like help in choosing a provider, please call our customer service department at the number on the back of your ID card. We can print you an up-to-date provider listing. We can help you find providers who provide covered care when you need it. We can help you find a provider who is taking new patients. We can even help you make an appointment if you like.

Definitely call us if you are unable to locate a provider using our online directory. If you would like help from a clinical staff member (doctor or nurse), we can connect you with one.

Always Call Your Primary Care Physician Before Seeking Care:

Always call or see your Primary Care Physician when you or your family members need medical care. In the case of an emergency, seek care immediately and call your Primary Care Physician as soon as possible after the emergency. Calling your Primary Care Physician allows him or her to coordinate and manage your care properly.

Remember to use a provider in your network of providers when you need specialty care. While you don't need a referral for in-network care, we encourage you to work in partnership with your Primary Care Physician to manage your health care.

You may someday need to change Primary Care Physician. It's easy to do so. To change your Primary Care Physician:

• Visit our Member Resource Center (available at http://www.bcbsvt.com/member/MWP_Prod.html). You will be able to select and change your PCP directly from the Member Resource Center, OR
• Select a new Primary Care Physician who is in your area (Again, each family member may select his or her own physician.) Then,
• Call the customer service phone number on your identification card and request the change, or
• Notify our account services department of the change by mailing an application form indicating your change of physician to:
  
  The Vermont Health Plan
  Account Services
  P.O. Box 186
  Montpelier, VT 05601-0186
  

No matter how you notify us of your change, it becomes effective the first of the month following our receipt of your request. Your new Primary Care Physician may wish to review your ongoing care, so contact him or her and introduce yourself as a new patient.

Getting Approval for Your Care:

While you do not need referrals from your primary care physician before seeking care from a specialist, you do need certain approvals from us for certain services and supplies. For example, if you are in a managed care plan, you must get prior approval from us before getting care outside of the network for your plan. All members, whether or not they have managed care, must get prior approval for certain services. Your subscriber contract, which you receive after you enroll, will list services that require prior approval It will tell you what penalties you pay for failing to get authorization. It will also tell you how to initiate a grievance or appeal if we deny, reduce, modify or terminate your coverage.

If you would like to read a certificate before you enroll, you may find one on our website at www.bcbsvt.com.

About Our Blue HealthSolutions Programs:

Blue HealthSolutions offers a suite of customized health and wellness programs and solutions to help members achieve and maintain their best health. Our nurses may call you to touch base with you about your care. Blue HealthSolutions will help ensure that you're getting the best care and screening available and help you comply with your doctor's treatment plan. Please know that our nurses' conversations with members are strictly confidential. Blue HealthSolutions programs are voluntary and available at no additional cost to our members. If you would like to find out what Blue HealthSolutions services and resources might meet your specific needs, call (800) 922-8778 and select option 1.