Selecting or Changing Your Primary Care Physician (PCP)
Health Advantage HMO and POS Members – if you need to select or change the PCP for yourself or a family member, call Customer Service at 1-800-843-1329.
PCP changes will be effective the first of the following month.
At the time of enrollment, you must select a primary care physician (PCP) from the
Provider Directory for your health plan. Your membership ID card will list the PCP
you select. Each member of your family covered by your health plan also must select
a PCP, but each family member may select a different PCP.
If you are enrolled in an HMO plan, covered services must be performed, prescribed,
directed or authorized in advance by your PCP and/or Health Advantage except in
an emergency or for gynecological services or a routine vision examination from
a participating provider.
If your services are not authorized by your PCP, your claims may be denied. Note
that your PCP will need to contact Health Advantage in advance for any referral
to out-of-network providers.
If you are enrolled in a POS plan, the key to obtaining in-network benefits from
Health Advantage is your PCP. Services allowed under your health plan that are performed,
prescribed, directed or authorized in advance by your PCP and/or Health Advantage
are covered as in-network benefits. Note that your PCP will need to contact Health
Advantage in advance for any referral to out-of-network providers.
You must contact your PCP prior to receiving any health services except in an emergency
or for gynecological services or a routine vision examination from a participating
provider. Your claims will be paid at the out-of-network level for services by either
an in-network or out-of-network provider if your PCP does not authorize those services
Open Access POS Members
Under Open Access POS, you self-direct to your choice of providers -- your PCP for
preventive and routine services or in-network or out-of-network specialists for
episodic care. Referrals are not necessary.
However, covered preventive services must
be performed by a PCP. Otherwise, those claims may be denied.
Even though you don't need referrals to specialists if you are enrolled in Open
Access POS, you should choose in-network providers to reduce your health care cost.
Copayments, deductibles and coinsurance are substantially higher if you choose out-of-network
providers. Arkansas State and Public School enrollees are not required to select a Primary Care Physician.
For a list of participating providers, go to the
For more information on referrals, see Member Referral