HealthLink Network Programs and Services Overview

	Network included in HealthLink Program
HealthLink Program	HMO (Tier I)	PPO (Tier II)	Workers’ Compensation	Out-of-Network*
Open Access III (OAIII)	✔	✔		✔
Open Access II (OAII)	✔			✔
PPO		✔		✔
Workers’ Compensation			✔

* Note out-of-network coverage is provided in accordance with the Member’s health plan.

Open Access Network Programs

HealthLink Open Access is a non-gatekeeper network program, and certain Payors may require pre-certification (refer to the Utilization Management section of this manual). Members may self-refer to participating Providers and Facilities.

Open Access III (OAIII) is a three-tier program: This program has three levels of benefits. The highest level of benefit is available to Members who self-refer to HealthLink HMO participating Providers or Facilities. A second, lower level of benefit is available to Members who self-refer to HealthLink PPO participating Providers or Facilities. The third, lowest level of benefit is available to Members who self-refer to out-of-network Providers or Facilities. HealthLink HMO contracted Providers and Facilities participate in Tier I. HealthLink PPO contracted Providers and Facilities participate in Tier II. Out-of-network Providers and Facilities are considered Tier III.

Open Access II (OAII) is a two-tier program: This program has two levels of benefits. The highest level of benefit is available to Members who self-refer to HealthLink HMO participating Providers and Facilities. A second, lower level of benefit is available to Members who self-refer to out-of-network providers. Only HealthLink HMO contracted Providers and Facilities participate in the OAII network program.

If a Provider or Facility is contracted in both the HMO and PPO networks, the Member’s highest level of benefits will be applied at Tier I.