Your PCP should be your first contact for any health care issue and must provide you with a referral to other health care providers. The only instances that you do not need a referral is when seeing an OB-GYN, chiropractor, mental health provider, and for routine eye exams. If you choose not to select a PCP, your medical expenses will be reimbursed as "out-of-network" as described below.
For employees who live outside of New England and choose not to select a PCP, your health care services will be considered out-of-network and subject to the deductible and coinsurance.
Other Important Information Regarding PCP Selection
If you enroll in MIT Choice and don't choose a PCP, your medical expenses will be reimbursed as "out of network" services. This means that you will pay the first $500 (per individual) and $1,000 (per family) in medical expenses to satisfy the annual deductible. After meeting the $500 individual or $1,000 family deductible, you will also be responsible for paying 25% of any medical bills for services received by a Blue Cross Blue Shield provider until the annual out-of-pocket dollar amount is reached. This is called co-insurance. The annual out-of-pocket amounts for services received from a Blue Cross Blue Shield provider are $2,500 per individual or $5,000 per family. The $500/$1000 deductible amount is included in these annual out-of-pocket amounts.
How to Choose a PCP
To choose a PCP at MIT Medical:
- Go to the MIT Medical Find a Provider web page, and search by your provider's name or select your options from the drop down menus. You can also call MIT Medical Claims and Member Services at 617-253-5979.
- As an MIT Choice member, you need to obtain the PCP name and identification number from the MIT Medical website, and then contact Blue Cross Blue Shield at 1-800-821-1388 with the PCP information, or log-on to MemberCentral on the Blue Cross website and enter the MIT Medical provider number in the My Account section.
To choose a PCP in the Blue Cross Blue Shield HMO Blue New England network:
Go to the BCBS Find a Doctor website and:
- Enter your provider's name and location
- Choose "HMO Blue New England" from the dropdown menu
- Click "Search"
You can also call Blue Cross Blue Shield at 1-800-821-1388 and provide them with your PCP name and the Blue Cross provider ID number.
Making a Change to Your PCP
Keep in mind that any changes to your primary care provider will not become effective until the first of the month following the date you make your PCP selection. For example, if you contact Blue Cross Blue Shield on January 15th, your PCP selection will not become effective until February 1st, which means that any medical care you receive from January 1st through January 31st will be reimbursed subject to the $500/individual or $1,000/family deductible and 25% coinsurance amounts as mentioned above.
MIT Traditional members should contact MIT Medical Claims and Member Services at 617-253-5979 to make a change to their PCP.
MIT Choice members should contact Blue Cross Blue Shield Member Services at 1-800-821-1388 to make a change to their PCP.