Provider and Pharmacy Directory

The directory provides a list of the providers in your plan that have agreed to provide you with your healthcare coverage. You may visit any of our plan providers listed in this directory. If you have been going to one plan provider, you are not required to continue going to that same provider. In some cases, you may obtain coverage for certain services from non-plan providers.

 

Under the HMO coverage, you will have to choose one of our plan providers that are listed in this directory to be your Primary Care Physician (PCP). Generally, you must receive your health care coverage from your PCP, who specializes in internal medicine, family medicine, general practice or geriatric, to which you will have access without a referral and who has a direct or indirect contractual arrangement with the Health Plan. A PCP provides you with primary care services; maintains the continuity of your medical care and initiates and manages referrals to other network providers as required by your medical needs and/or as established in your coverage. To receive services from a non-plan provider you will need preauthorization from the plan.

 

For PPO coverage, you do not have to choose a Primary Care Physician (PCP); you have the option of using contracted and non-contracted providers. However, if you choose to visit a nonplan provider, with the exception of emergencies or urgent care situations, renal dialysis and hospitalization (when admitted through the emergency room) it may cost you more. 

 

The service areas of Medicare y Mucho Más (MMM), PMC Medicare Choice (PMC) and First+Plus include all municipalities in Puerto Rico.

 

To get detailed information about your healthcare coverage, please refer to your Evidence of Coverage. For more information, call our Member Services Department.

 

 

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