Office Visit
Provider Type
- Physicians
- Participating Physician Groups (PPG)
Office visits to a physician, physician assistant (PA) and nurse practitioner (NP), and specialist consultations at a participating physician group (PPG), are covered on all Health Net plans. Specialist consultations are covered when referred by the member's primary care physician (PCP).
Well-Woman Self Referrals
The well-woman self-referral benefit allows female members to self-refer to an obstetrician/gynecologist (OB/GYN) within the member's selected PPG for obstetrical and gynecological physician services. Services received as part of a well-woman visit are considered an OB/GYN self-referral under the specialist consultation visit and the PPG may establish reasonable requirements for the OB/GYN to communicate with a member's PCP regarding the member's condition, treatment and any need for follow-up care.
Coverage Explanation
Office visits, consultations with a participating provider, or any necessary referrals for care by a provider other than the member's primary care physician (PCP) are covered and subject to the scheduled copayments.
Refer to the plan chart in the Schedule of Benefits and Summary Benefits for the standard benefit and copayments for office visits if applicable.