Medicare y Mucho Más HMO, SNP & POS Plan Provider and ... - MMM

Section 1 - IntroductionThis directory provides a list of MMM's network providers. To get detailed information about your health carecoverage, please see your Evidence of Coverage.You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician(PCP). The term "PCP" will be used throughout this directory. Generally, you must get your healthcare coverage fromyour PCP. A PCP is a physician with a specialty in internal, family, general practice or geriatric medicine to which youwill have direct access without a referral and who has a direct or indirect contractual arrangement with the plan. A PCPprovides you initial and primary care services, maintains the continuity of your medical care and initiates and managesreferrals to other network providers as required by your medical needs or as established in your coverage.The "network providers" listed in this directory have agreed to provide you with your healthcare coverage. You may goto any of our network providers listed in this directory; however, some services may require a referral orpreauthorization. If you have been going to one network provider, you are not required to continue going to that sameprovider. In some cases, you may get covered services from non-network providers. To receive services from a nonplan provider you will require prior authorization from the plan.What if I use non plan providers to obtain my covered services?"Non plan providers" are providers that are not part of MMM. If you use non plan providers, you may have to paymore.Care or services you receive from non plan providers will not be covered, except for ambulance services, emergencycare, including hospital care after you are stable (post stabilization), maintenance care, urgently needed care, renaldialysis (kidney), and any services which were ordered or covered through an appeals process or if you have a coveragewith Point of Service (POS) option.Please note that under the HMO POS coverages you have a Point-of-Service (POS) option. The POS option allowsyou to get care from non contracted providers and hospitals when you are outside the service area. You may receive allplan covered services, but you will need to pay higher cost sharing than the one you pay when using network providers.This is not the same benefit as visiting out of network physicians and/or hospitals during an emergency or an urgent caresituation. Please refer to Chapter 3 and Chapter 4 of your Evidence of Coverage for more information about your POScost sharing, cap on the dollar amount and prior authorization requirements.Page 9