Beginning January 1, 2006, the out-of-area provider network will change from the CCN Network to the Private Healthcare Systems (PHCS) Network.  PHCS's network includes over 440,000 providers and over 4,200 facilities, located throughout the United States.

How Does This Change Affect You?

 PPO Members
 HMO and POS Members

PPO Members

In our Premier PPO plans, when you travel nationwide, your health coverage goes with you. Follow these easy steps for health coverage when you travel throughout the United States:

• In an emergency, go directly to the nearest hospital or call 911.
• Always carry your current Optima Premier PPO Member ID card. To locate a participating provider visit www.phcs.com and select PPO providers, or call 1-888-817-7427.
• Obtain any necessary pre-certification or prior authorization by calling the number listed on your member ID card.
• When you arrive at the participating provider's office or facility, simply present your Optima Premier PPO ID card.

By displaying your new Optima Premier PPO member ID card to your PHCS provider, the PHCS provider will recognize that you are an Optima Premier PPO member and will help to ensure that you receive the in-network PPO level of benefits for covered services.

After you receive care:

• There are no claim forms to file for covered services.
• There are no additional out-of-pocket expenses for medical services other than the usual in-network out-of-pocket expenses (non-covered services, deductible, copays, and coinsurance).

You will receive a complete Explanation of Benefits (EOB).

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HMO and POS Members
 

You can use the PHCS network if you have an urgent or emergent care need while traveling outside of the service area. 

Keep the following in mind if you need to use the PHCS network:

• In an emergency, go directly to the nearest hospital or call 911.
• You still need to follow all health plan policies and procedures to ensure coverage. Refer to your health plan document for details.
• To research PHCS participating providers visit www.phcs.com and select the Healthy Directions network, or call 1-888-972-7427.

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Additional Information

Want to nominate a physician that is not currently part of the PHCS network?  Simply fill out the Provider Nomination Form on http://www.phcs.com/.

Questions?  

Contact Member Services or call PHCS at 1-888-817-7427(PPO Members) or 1-888-972-7427(HMO Members).