PCP Coordinated Care HMO (PCP-HMO) Plans
- Our PCP Coordinated Care HMO (PCP-HMO) plans offer a supported healthcare experience and reduced out-of-pocket costs. Members have an assigned PCP to help coordinate care. For detailed information (perfect for staff training), download an overview of our PCP-HMO plans and networks [PDF] or the PCP-HMO e-learning slides. [PDF] (Education & Training > Provider E-learning)
Here are the 2023 benefit plan names, networks, and prefixes associated with PCP-HMO plans:
Note: “Ascend” PCP-HMO plans are available only to large employer groups and may not include all of the qualified health plan (QHP) benefits. Ascend plans are different from those available to small groups and individuals/families (check eligibility and benefits for plan-specific information):
- Ascend plans use an open formulary that is different from the QHP formulary.
- Ascend plans do not include dental/vision benefits for members under age 19.
- Request tool for PCP referral approvals and prior authorizations (Practice Management > PCP Coordinated Care HMO Plans > Prior Auth Requests-Non-Std Option)
- PCP Panel Rosters
- Form-Covering PCPs
- Form-PCP Consent