| SJC offers two Health Maintenance Organization (HMO) plans, as well as two Preferred Provider Organization (PPO) plans. Following is a brief description of each plan type. For detailed information, refer to summaries and provider links.
Presbyterian & Lovelace HMO Plans
PCP Coordinated. With an HMO plan, your PCP coordinates your care, which means that generally you must contact him or her to be referred to a specialist or to obtain an authorization. You are charged a co-payment for various services. There are no claim forms necessary; the physician's office takes care of the paperwork. General care and routine exams, including OB/GYN, are provided without referrals. You also have access to specialists through your primary doctor, who handles all referrals and paperwork.
BCBS & United Health Care Triple Option PPO Plan
Blue Cross Blue Shield & United Health Care gives you three ways to manage your healthcare. PCP Coordinated. A primary care physician coordinates your care. You choose any PCP from the statewide network and pay only the copayment for most benefits. This level is the easiest and least expensive way to receive care. There are no claims to file and no deductibles to meet. General care and routine exams, including OB/GYN, are provided without referrals. You also have access to specialists through your primary doctor, who handles all referrals and paperwork. You are not locked into one PCP.
Self-Coordinated Using in-Network physicians. You manage your own health care with physicians and other providers from the network. You don’t need a PCP referral to see a specialist. This benefit level includes a deductible and coinsurance.
Self-Coordinated using Out-of-Network physicians. You manage your health care by seeing any provider you choose, anywhere. This level includes a deductible, coinsurance, and any amounts above the maximum allowable fee.
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