WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 2 Part 1 Member Services Your Primary Care Provider As a member of this health plan, you are not required to choose a primary care provider to coordinate the health care benefits described in this Subscriber Certificate. However, your PPO health care network includes physicians who are family or general practitioners, internists, pediatricians, geriatric specialists, nurse practitioners, and physician assistants that you may choose to furnish your primary medical care. You may choose any covered provider to furnish your health care services and supplies. But, your choice is important because it may impact the costs that you pay for some health care services. How to Determine a Preferred Physician’s Specialty To determine a preferred physician’s specialty, you can look in your PPO provider directory or use the online “Find a Doctor” physician directory. Some preferred physicians may have more than one specialty. When your health plan has a cost share that differs based on the preferred physician’s specialty type, Blue Cross Blue Shield HMO Blue will use the primary specialty type as shown in the PPO provider directory to determine your cost share amount. For example, a preferred physician may be primarily a dermatologist but may also be a family practitioner. In this case, your cost share amount is determined based on the “dermatologist” specialty type since it is the preferred physician’s primary specialty as shown in the Blue Cross Blue Shield HMO Blue PPO provider directory. A preferred physician may change their specialty at any time. However, Blue Cross Blue Shield HMO Blue will change a preferred physician’s specialty only once every two years. Some preferred physicians and other professional provider types are part of a multi-specialty provider group. When your health plan has a cost share that differs based on the preferred physician’s specialty type, Blue Cross Blue Shield HMO Blue will apply the lower cost share amount for primary care provider specialty types to the multi-specialty provider groups. In other states, the local Blue Cross and/or Blue Shield Plan may have established provider specialty types that are not recognized by Blue Cross Blue Shield HMO Blue. In those cases when a preferred physician’s specialty type or professional provider type is not recognized, Blue Cross Blue Shield HMO Blue will apply the higher cost share amount for specialists and other non-primary care provider specialty types. Refer to the Schedule of Benefits for your plan option to see if your cost share amount is based on a preferred physician’s specialty type or other provider type. Your Health Care Network This health plan consists of two benefit levels: one for in-network benefits; and one for out-of-network benefits. The costs that you pay for covered services will differ based on the benefit level. To receive the highest benefit level (your in-network benefits), you must obtain your health care services and supplies from providers who participate in your PPO health care network. These health care providers are referred to as “preferred providers.” (See “covered providers” in Part 2.) If you choose to obtain your health care services and supplies from a covered provider who does not participate in this PPO health care network, you will usually receive the lowest benefit level (your out-of-network benefits). See Part 8 in this