Local Medical Providers

• HMO stands for Health Maintenance Organization; an Organization (medical group) is prepaid to Maintain your Health. When you pick your PCP, you are also choosing, in advance, the medical group to which your doctor belongs—as well as the specialists and hospitals that you may use for non-emergency care. That medical group will be prepaid to treat you, and you will generally be limited to that group except for emergencies, urgent care more than 30 miles from the group, and mental/behavioral health services (unless you obtain prior authorization). 
• If you choose an HMO, you must also choose a Primary Care Physician (PCP) within 30 miles of your home/work/school (for retirees, within 30 miles of your home).
• Your plan will usually let you change PCPs and groups mid-year; simply call the plan to request a change.
• If you don’t choose a PCP, you may be assigned one.
• For Health Net, each covered family member can have a different PCP and/or different medical group.
• For Kaiser, each family member can have a different PCP, but Kaiser contracts with only one large group, the Permanente Medical Group of Northern California, and members must use Kaiser hospitals & pharmacies.

You can search for individual doctors using your medical plan's website.

• PPO = Preferred Provider Organization. When you have a PPO plan, you should always use "preferred providers." (Retirees with Medicare can skip to the Medicare PPO section.) They are preferred because they have a contract with your plan. That contract protects both you and the plan, because preferred providers cannot “balance bill” (charge more than the contractual rate with your plan). Blue Shield PPO providers (and UC Select providers for UC Care) are considered In-Network because they have a contract with your plan. Out-of-Network providers have no contract limiting what they can charge; the patient is responsible for balance billing.
• Be sure to check with your insurance company to verify that they contract with your providers.  If you intend to see a new doctor, also verify availability with that doctor’s office. While most providers in the medical groups shown are likely to contract with your plan, know that doctors contract with PPO networks individually; not all doctors/hospitals/labs/etc. within a medical group necessarily contract with the same PPO networks. You can search for individual doctors using your medical plan's website.
• HealthSavings+, UC Care, UC High Option, UC Medicare PPO, and UC Medicare Choice members are not limited to prepaid medical groups and are not required to choose a PCP.

For Medicare PPOs:

• For Anthem Blue Cross plans where Medicare is the primary payer (UC High Option, UC Medicare PPO): any Medicare provider can be used; see see medicare.gov to search for providers. Exception: use Anthem Preferred providers for services covered by your plan but not covered by Medicare (e.g. hearing aids, acupuncture).
  
  Note: Sutter-affiliated PCPs are not accepting new Medicare patients in the Davis/Sacramento area. Sutter does have PCPs accepting new Medicare Advantage patients.
• For the retiree Medicare Advantage PPO plan UC Medicare Choice (UnitedHealthcare), any Medicare provider can be used; see medicare.gov to search for providers.
  
  Note: providers bill UnitedHealthcare, not Medicare.