How HMOs Work

How It Works

Your Primary Care Physician (PCP)

When you enroll in an HMO, you must choose a Primary Care Physician (PCP). Your PCP coordinates all of your medical care. When you need care, you must call or visit your PCP first. If it is medically necessary, he or she will refer you to a specialist. Your PCP’s responsibilities include:

Giving you regular checkups.

Providing treatment when you are ill.

Ordering necessary X-rays, lab work and other tests.

Referring you to a specialist.

Arranging for outpatient treatment or hospitalization.

Filing your claims.

Each member of your family may have his or her own PCP.

You can change your PCP as often as you want (monthly for UCHP). To change your PCP, call your HMO. Generally, if you call your HMO before the middle of the month, the change will take effect on the first day of the following month.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.