These data reflect the most commonly purchased benefits package for each of the health plans in
the year 2000. Coventry/Principal would not supply updated information.

HMO Urgent Care
Aetna US Healthcare Covered outside service area.
Blue Cross Blue Shield Within service area: Contact your PCP, call the 24 hour nurse line, or visit a participating urgent care provider. Use of an urgent care provider is limited to after-hour services, weekends or holidays. No PCP referral is needed to see an urgent care provider. However, routine or other non-urgent care will not be covered by BCBS. referrals from the PCP or nurse line for urgent care will be guaranteed payment.

Services outside of service area: Contact your PCP by phone within 2 days or the first business day, whichever is later. If you are required to pay for urgent care services immediately, contact the Member Services Department to request a subscriber claim form.

Note: If you live outside of the service area, services for urgent care will be covered if you received treatment within the service area from your PCP or from a participating urgent care Provider after normal doctor’s office hours, on weekends and/or holidays. Continued and follow-up treatment must be arranged in advance by your PCP.

Cost Sharing: Copayments apply for urgent conditions.

Excludes: If BCBS decides the condition did not require urgent care, you will be responsible for all charges.
CIGNA / Healthsource Within Service Area: Same procedure as emergency services when provided by an in-plan urgent care facility, or by a member's PCP or a consulting specialist with referral from a PCP.

Services Outside of Service Area: CHCNC will cover urgent care when medically necessary, including urgent care for students away at school, and members on vacation. Urgent care received at any facility must meet CHCNC’s definition of urgent care for services to be covered.
Doctors Health Plan Covers: Same as emergency care.

Cost Sharing: Copayments may apply.
Generations Covers: Urgent care within service area.

Limits: Members should contact their PCP, who will direct them to the most appropriate location for treatment, either his/her office or one of Generations’ Participating urgent care centers.

Optimum Choice Covers:
  • Outside Plan Service Area: If a condition requiring urgent care develops while you are outside the service area, you should seek care from a local doctor or hospital emergency room if necessary. You should notify your PCP prior to receiving services whenever possible to ensure coverage. Care provided outside the service area will be covered only if OCCI determines that the member can not reasonably return to a participating provider or hospital.

Cost Sharing: Copayments apply.
PARTNERS Covers: Services at an urgent care center will be covered if medically necessary.

Limits: Members should contact their PCP, who will instruct them to do one of the following:

  • Go to the PCP’s office,
  • Go to a specific physician’s office,
  • Go to an emergency room of a participating hospital, or
  • Go to a participating urgent care center.
Coventry/Principal Health Care of the Carolinas Covers:
  • Urgent care within the service area. If a condition requiring urgent care develops while you are in the service area, you must call your PCP’s office for medical evaluation and instructions.
  • Urgent care outside the service area - If a condition requiring urgent care develops while you are outside the service area, go to the nearest urgent care center, physician’s office or any other provider for treatment.

Limits: You must notify Coventry/Principal within 48 hours, condition permitting. The condition must be a covered service and be retroactively approved by Coventry/Principal. Payment shall be limited to treatment required before the member can safely return to the service area for necessary follow-up.

Cost Sharing: Copayments may apply
QualChoice Covers: Urgent care within the service area. enrollees have the option of going to an urgent care Center as opposed to an Emergency Room.

Cost Sharing: Copayments apply.
The Wellness Plan of North Carolina, Inc. For non-emergent conditions, a member is required to contact his or her PCP or call the 24-hour nurse advice line to be directed to the appropriate medical facility for treatment and/or receive prior approval for urgent care facility services.

Note: The Evidence of Coverage does not distinguish between services within the service area and services outside of the service area.
United HealthCare Within Service Area: Covers services and supplies provided at a participating urgent care center.

Cost Sharing: Copayment may apply.

Outside of Service Area: Covered when:

  1. Medical need is so serious that the health of the member would be risked if taken to a participating facility where a participating physician would be available.
  2. Member is unable, because of his/her condition, to request treatment from a participating provider.

Cost Sharing: Member pays 20% of the first $5000 of eligible expenses ($1000 maximum copayment).
WellPath Covers: Urgent care for medical services.

In area urgent care: Member should first seek care through the PCP. If the PCP is unavailable, the member should seek care at a participating urgent care center.

Out-of-area urgent care: Follows the same rules as for emergency care.

Cost Sharing: Copayments apply.

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