HOW TO OBTAIN SERVICES The provider network for this Deductible Plan is the Classic network. The Classic network includes Participating Providers who are either employed by us or contract directly or indirectly with us to provide covered Services for Members enrolled in this Deductible Plan. You pay the Cost Share amount shown on your “Benefit Summary” when you receive covered Services from Participating Providers and Participating Facilities. To receive covered benefits, you must obtain Services from Participating Providers and Participating Facilities except as described under the following sections in this EOC: “Referrals to Non-Participating Providers and Non-Participating Facilities.” “Emergency, Post-Stabilization, and Urgent Care.” “Receiving Care in Another Kaiser Foundation Health Plan Service Area.” “Out-of-Area Coverage for Dependents.” “Ambulance Services.” To locate a Participating Provider or Participating Facility, contact Member Services or visit kp.org/doctors to see all Kaiser Permanente locations near you, search for Participating Providers, and read online provider profiles. We will not directly or indirectly prohibit you from freely contracting at any time to obtain health care Services from Non-Participating Providers and Non-Participating Facilities outside the Plan. However, if you choose to receive Services from Non-Participating Providers and Non-Participating Facilities except as otherwise specifically provided in this EOC, those Services will not be covered under this EOC and you will be responsible for the full price of the Services. Any amounts you pay for non-covered Services will not count toward your Deductible (if any) or Out-of-Pocket Maximum. Primary Care Participating Providers You may select a Primary Care Provider (PCP) at any Participating Medical Office when enrolling in this Plan. One PCP may be selected for the entire Family or a different PCP may be selected for each Family Member. Except for qualifying Emergency Services or authorized referrals, Members must use Participating Facilities. For information about choosing your primary care Participating Provider, please call Member Services or visit kp.org. Female Members also have the option of choosing a women’s health care Participating Provider as their primary care Participating Provider, as long as the women’s health care Participating Provider accepts designation as primary care Participating Provider. A women’s health care Participating Provider must be an obstetrician or gynecologist, a physician assistant specializing in women’s health, an advanced registered nurse practitioner of women’s health, or a certified nurse midwife, practicing within their applicable scope of practice. You may change your primary care Participating Provider at any time by calling Member Services. The change will take effect immediately. Once the Member changes PCPs, any referrals that were made by the previous PCP are valid as long as the referral was authorized by Medical Group. The Member should notify the new PCP that they have been receiving specialty Services from a Participating Provider, so the PCP can make arrangements for the Member to continue to receive specialty Services. Women’s health Care Services Female Members shall have direct and timely access to Participating Providers specializing in women’s health care (WHC) Services. WHC Services are provided by a participating family medicine physician, physician’s EWCLGDED1983ACT0124 30 WAPEBB-CL-ACT
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