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Urgent care centers and retail health clinics are alternatives to the ER when physicians are unavailable

June 1, 2015

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We would like to remind you of the urgent care benefit available for most Independence members. This benefit allows members to receive services for urgent medical issues that do not require the advanced medical services of the emergency room/department (ER) when their physician is unavailable. Generally, urgent care is categorized as medically necessary treatment for a sudden illness or accidental injury that requires prompt medical attention, but is not life-threatening and is not an emergency medical condition, when a member's primary physician is unavailable.

Eligible members can receive urgent care in the following places:

  • Urgent care centers. A health care facility that can provide medically necessary treatment for a sudden illness or injury that requires prompt medical attention but is not life-threatening.
  • Retail health clinics. A health care facility staffed by certified nurse practitioners that can treat minor, uncomplicated illnesses and injuries.
Approved urgent care centers and retail health clinics can be found by using our Find a Doctor tool. Select Search under Find a Doctor. Then select Urgent Care Center & Retail Clinic from the first drop-down menu and enter your additional search criteria. These approved providers may treat members without a referral or authorization.

You may want to print out a list of the approved urgent care centers and retail health clinics in your area to keep on hand and share with the staff who handle after-hours calls. This list may be instrumental in cases when a member requires urgent medical attention, but your office is closed and ER care is not necessary.

Note: Not all members are eligible for the urgent care benefit. As always, continue to check the NaviNet® web portal for member eligibility and cost-sharing amounts.

Coverage for CHIP members

All Children's Health Insurance Program (CHIP) members are enrolled in the Keystone Health Plan East HMO program, which includes coverage for urgent care and retail health clinic visits.

CHIP members are issued an Independence member ID card with the words "PA KIDS" written on the front, as shown on the sample CHIP ID card below:

PA Kids ID card sample

If you have any questions about the urgent care or retail health clinic network, please call Customer Service at 1-800-ASK-BLUE.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

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