The Primary Care Network (PCN) is an employer-sponsored, managed care program
available through USAble Administrators, which can be integrated into the
specific benefit plan and funding arrangement of a self-funded employer group.
Primary care physicians (PCPs) serve as "patient managers" to appropriately
manage secondary and tertiary referrals (specialty care) with the expectation
that unnecessary treatment and hospitalization can be limited. The PCN is
offered as an option to a standard medical plan or other managed care programs
for the employee's health-care coverage.
Health-Care Cost Management
The PCN encourages use of health-care services in the most efficient and
cost-effective setting. To manage health-care costs, the PCN limits patient
self-referrals by enforcing referrals controlled by the employee-selected PCP.
Primary Care Physician Selection
To participate in a PCN, each member must select a primary care physician
(PCP). Members must choose from physicians authorized to participate in their
If you are a PCN member, contact your employer for a listing of PCPs who
participate in your network. You may change your PCP selection by completing a
change form, which is available from your employer's group administrator.
Consult the group administrator to find out how often you may change
your PCP selection.
Every primary care physician is required to have a backup. If your PCP is not
available, request services from the backup physician.
Referrals to Specialty Care
In addition to the PCN, your plan may access a specific network of providers
for referred services (specialty care). As an example, you may have a PCN/PPO
plan. That means that if your PCP refers you for specialty care, the referral
must be to a Preferred Provider Organization (PPO) provider for you to receive
the highest level of specialty benefits. The specialist must participate in the
For more information, see Referral
Process for Primary Care Network (PCN).