How the Pequot Open Plan Works

If you go out-of-network for physician and ancillary services …

… you have benefits and your out of pocket remains the same.

The plan offers a choice. Each time you need care, you decide which provider to see. You can receive care from one of the preferred providers for physician and ancillary services or from any other provider. The plan does not have a network for hospital and facility services, such as outpatient diagnostic and surgical facilities. You can visit any facility that provides the services you need and the Plan will reimburse your covered charges up to the Maximum Allowable Amount, which is outlined in the Your Medical Plan section.

There is no requirement to see a “primary care physician” or obtain a referral before seeing a specialist.

Certain services must be pre-certified for you to receive full benefits. See “Pre-Certification” within this section for more information.

The network for physician and ancillary services may change from time to time. A change in the membership of the provider network is not considered a qualified change in status for mid-year changes in coverage.