How Exclusive Care Works

As a member of Exclusive Care, you and all enrolled family members are each required to select a Primary Care Provider (PCP).

Your PCP will coordinate and provide medical services to meet your needs. If you do not select a Primary Care Provider when enrolling, a provider will automatically be assigned to you based on your home zip code.

If it is determined that specialty care is required, your PCP will make a request to Exclusive Care on your behalf. If your PCP determines lab or radiology work is needed, you may take the lab work order or direct referral to the most convenient network lab or radiology location. All specialty services require prior authorization.

After you have selected your PCP and completed your Benefit Election/Open Enrollment Form, you will receive a “New Enrollment Packet” that will include your Exclusive Care identification card once your paperwork is processed.

As long as you stay within the Plan guidelines, there is minimal out of pocket expense and no additional paperwork for you to complete!

Please be sure to read your Summary Plan Documentincluded in your “New Enrollment Packet” thoroughly to fully understand these guidelines and benefits as well as the exclusions and limitations.

Selecting Your Primary Care Provider

When selecting your PCP, please keep in mind:

  • The PCP you choose must be located within a 30 mile radius of your primary residence or workplace.
  • If each enrolled family member prefers to choose a different PCP, they may do so.
  • If your PCP leaves our network, you must choose a new network PCP.
  • If a PCP has closed their office to new patients, you must select another PCP.