HMO Direct Access Option

This plan design is similar to the HMO plan. With this type of plan the member can self-refer to a physician who is not their primary physician. Typically the physician needs to be within the same network the member’s primary is in. The self-referred office visit is higher ($30). If the member needs lab work performed, they should have that done by their primary physician’s designated lab. Certain rules vary with this plan design. It is important to know how the plan works before using it, otherwise the member can have tests done and not have them covered. Aetna, HealthNet and Blue Shield HMO plans offer plans with this option.