This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
Nonprofit health plan providing 6 million Californians with affordable healthcare coverage including HMO, PPO, dental, and vision plans for individuals, families, and employers.