Services that Do Not Require a Referral
The following are examples of services that do not require a referral from your PCP.
Routine women’s health care, including breast exams, mammograms, Pap tests,
and pelvic exams (must see in-network specialist).
- Routine dental services (must see in-network dentist).
- Routine vision exams (must see in-network provider).
- Flu shots, hepatitis B, and pneumonia vaccinations.
- Transportation to or from a plan-approved location provided by an Essence transportation provider (for plans where this benefit is available).
- Visits to a participating SilverSneakers® fitness center.
- Emergency services, whether you get these services from in-network providers or out-of-network providers.
Urgently needed care that you get from out-of-network providers when you are temporarily outside the Plan’s
service area. Also, urgently needed care that you get from out-of-network providers when you are in the
service area but, because of unusual or extraordinary circumstances, the in-network providers are temporarily
unavailable or inaccessible. The emergency room co pay applies to urgently needed care visits outside of the U.S.
Dialysis (kidney) services that you can get when you are temporarily outside the Plan’s service area.
If possible, please let us know before you leave the service area where you are going to be so we can
help arrange for you to have maintenance dialysis while outside the service area.
- Behavioral health visits from a network provider.
*List is not all inclusive and is subject to change and is only applicable if your plan requires a referral.