Health Care 101
Make smarter decisions for your health
Before choosing a plan, use this guide to make an informed decision.
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HEALTH CARE 101
Better health
starts
with Blue
WELCOME
We deliver a
health care
experience that:
- Is easy to understand
- Is simple to manage
- Goes beyond expectations
WELCOME
We deliver a
health care
experience that:
Before choosing a plan, use this
guide to make an informed decision.
LEARN
We're in the business of improving your health
MEMBER-FOCUSED
PERSONALIZED
CARE
Your plan revolves around
your unique health needs.
ACCESSIBLE,
NATIONWIDE
NETWORKS
Our networks in
Massachusetts, New
England, and beyond offer
access to the best
doctors, hospitals, and
specialists.
DATA-DRIVEN
INNOVATION
PERSONALIZED
FOR YOU
We provide leading-edge
solutions to improve your
health and well-being.
THE MOST TRUSTED
BRAND IN HEALTH
BENEFITS
With over 80 years of
dedicated service, we've
earned our reputation as
America’s #1 health brand.
UNDERSTAND
With your
Blue Cross ID card,
you’re covered.
Get to know your plan inside and out-
including how it works, what's covered,
and what you'll pay for covered services.
Understand: Plan Types
Get familiar with your Plan options
HMO (HEALTH MAINTENANCE ORGANIZATION)
Our HMO Blue New England plans give you access to New England's best doctors and hospitals. With an HMO, you're:
- Required to choose a primary care provider (PCP)
- Required to get a referral from your PCP to see specialists
- Covered when receiving care from in-network doctors and hospitals
PPO (PREFERRED PROVIDER ORGANIZATION)
Our PPO plans offer greater flexibility and a wider network of doctors and hospitals to choose from. With a PPO plan, you are:
- Not required to choose a primary care provider (PCP), although it is recommended
- Not required to get a referral to see a specialist
- Covered for care received in- and out-of-network, but you may have to pay more for out-of-network care
Understand: Compare Plans
Here are some key differences:
| Question | HMO BLUE NEW ENGLAND | PPO |
|---|---|---|
| Where can I be seen? | You can see network providers within Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. | You can see providers in our national network. |
| Is it covered if I go out of my network? | Only urgent and emergency care are covered out of network. | Yes, but you pay more of the cost and all amounts over allowed charges. |
| Do I need a PCP? | Yes, you're required to select a PCP. | No, you aren't required to select a PCP. |
| Do I need referrals to see specialists? | Yes, your PCP must refer you to specialists within your network. | No, you don't need a referral to see a specialist. |
UNDERSTAND: KEY TERMS
KEY TERMS FOR UNDERSTANDING YOUR PLAN: YOUR COSTS
Depending on your plan type and design, you may have
to pay one or more of these out-of-pocket costs.
| Term | Definition |
|---|---|
| Deductible | The amount you pay before your insurance begins picking up any of the costs for certain services. |
| Co-insurance | A percentage of the cost a doctor or hospital charges that you're required to pay. |
| Copayments | The costs you're required to pay for certain services or prescription medications. Your copayments will vary depending on your plan and the type of service or medication; however, in some instances, care may not be covered. |
UNDERSTAND: KEY TERMS
KEY TERMS FOR UNDERSTANDING YOUR PLAN: GETTING CARE
Using your plan is easier when you understand these terms.
| Term | Definition |
|---|---|
| Primary Care Provider | A provider, usually a family or general practitioner, internist, or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals, and other providers as necessary. |
| In-Network Provider | Any health care provider (doctor, hospital, etc.) that belongs to a health plan's network. Using an in-network provider will usually cost members less in copayments or co-insurance. |
| Out-of-Network Provider | Any health care provider that doesn't belong to a health plan's network. Members can see out-of-network providers, but will pay significantly more for services. |
CHOOSE
Choosing the
plan that's
right for you
Here are three questions that can help
you find the right plan.
CHOOSE
1. Who will be covered by your plan?
Our Plan Options: *
* Available plan options may vary.
CHOOSE
2. How often do you need medical care?
Preventive: You expect to primarily receive preventive care,
which is generally covered when received in network.
Both HMO and PPO plans cover preventive care when
received in network. (You may have to pay for services to
check on an existing issue or to diagnose a health concern.)
Occasional: You don't expect to receive
frequent medical care.
With an HMO: Referrals are needed.
Your PCP coordinates your care using in-network providers.
With a PPO: No referral is needed.
You have the flexibility to use out-of-network providers.
Frequent: You anticipate the need for
frequent medical care.
A PPO is more flexible. You and/or your family frequently
require medical care for chronic conditions, and you can see
specialists without a referral.
CHOOSE
3. How would you prefer to pay for care?
Pay less for my medical coverage out of my paycheck,
knowing I may be responsible for more in
out-of-pocket expenses when I need care.
Pay more for my medical coverage out of my paycheck
in return for set out-of-pocket costs when
I need care.
Typically, health plans that have higher premiums,
or cost per paycheck, offer lower deductibles.
If you expect to receive frequent care or have a
scheduled surgery in the next year, a lower deductible
may help offset the monthly costs.
USE
YOU’RE NEARLY
READY TO PUT
YOUR PLAN TO USE
USE
ACCESS TO THE RIGHT TOOLS
AT THE RIGHT TIME FOR YOU
FIND A DOCTOR & ESTIMATE COSTS
Find care wherever you
need it, and know the cost
before you go.
WELL CONNECTION
Live video visits with
doctors, providers, and
behavioral health
professionals.
Health Care 101
Get to know your
plan options
See the plans your employer is offering,
along with detailed explanations of your
access, benefits, and costs.
Learn
the benefits of choosing Blue
Understand
your plan options
Choose
the right plan for you
Use
your plan to the fullest
Effective: 7/1/2023
Welcome MIIA Town of Mattapoisett
GET THE MOST OUT OF YOUR PLAN
VIEW EKIT
VISIT MYBLUE
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FIND A DOCTOR
Search for a doctor, health care professional, or medical facility near you. You’re one click away from finding the care you need.
MEDICATION LOOK UP
Search for any medication, see what your plan covers, and find covered alternatives to non-covered medications.
CONTACT US
Questions about your plan? We’re here to help. Find out how to get in touch with us.
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UNDERSTANDING YOUR PLAN AND BENEFITS
Access additional tools to help you understand how your insurance works.