Members in a gated plan choose a network PCP at the time of their enrollment. If not, we assign one. A PCP is a physician in family practice, internal medicine, pediatrics, or general practice. Other specialties may be included if required by state law.
The PCPs designated by the member and enrolled dependent(s) do not need to be the same person, or affiliated with the same group. The member and enrolled dependent(s) must select a PCP within the geographic area where the subscriber lives.
You can verify a member’s assigned PCP when you verify their eligibility, as shown in the Verifying Eligibility, Benefits, and Your Network Participation Status section in Chapter 2.