Getting the Most Out of Your Plan

HealthyBlue is designed to reward you for achieving and maintaining a healthy lifestyle, and to help you to control your health care costs.

Here are some tips for getting the most our of your HealthyBlue plan:

  • Use your PCP for all preventive care – no cost!
  • See your PCP for a referral when you need specialty care – no cost! (copays and deductibles apply in HRA/HSA compatible plans)
  • Use HealthyBlue Select Generics when possible – no-cost!

How could your choices affect your out-of-pocket expenses?

To help guide you through the differences between using an in-network or out-of-network provider, the chart below shows a member accessing care through all three options.

Please note that this example may not represent your costs based on your own HealthyBlue plan.

Triple Option

  Option 1 Option 2 Option 3
You have leg pain
while running.		 You have leg pain
while running.		 You have leg pain
while running.
You visit your PCP
who requests an
X-ray and gives
you a referral to
Advanced Radiology.

You Pay $0.

 You bypass your PCP
and visit a BlueChoice orthopedic specialist who requests an X-ray and
gives you a referral to Advanced Radiology.

You Pay $100.*

 You bypass your PCP and
visit a CareFirst PPO or other orthopedic specialist who determines an X-ray is needed and does the X-ray in his office.

You Pay $250.*
You visit
Advanced Radiology
to get an X-ray.

You Pay $0.

 You visit
Advanced Radiology
to get an X-ray.

You Pay $0.

 You get an X-ray at
the specialist's office.

You Pay $225.*
PCP reviews results, determines nothing is broken and calls you with results. Specialist reviews results, determines nothing is broken and calls you with results. Specialist reviews results, determines nothing is broken and calls you with results.
 

your
out-of-pocket:

$0

your
out-of-pocket:

$100

your
out-of-pocket:

$475

*Allowed benefit applies to deductible.

How could your choices affect your out-of-pocket expenses?

To help guide you through the differences between Option 1 and 2, the chart below shows a member accessing care through both options. The examples below assume you have met your Option 1 deductible.

Please note that this example may not represent your costs based on your own HealthyBlue plan. This is what the cost differences may be among each option assuming you have met your Option 1 deductible.

HealthyBlue Dual Option

  Option 1 Option 2
You have leg pain while running. You have leg pain while running.
You visit your PCP who requests an
X-ray and gives you a referral
to Advanced Radiology.

You Pay $0.

 You bypass your PCP and visit a
BlueChoice orthopedic specialist who
requests an X-ray and gives you a
referral to Advanced Radiology.

You Pay $100.*
You visit Advanced Radiology
to get an X-ray.

You Pay $20.

 You visit Advanced Radiology
to get an X-ray.

You Pay $20.
PCP reviews results,
determines nothing is broken
and calls you with results.		 Specialist reviews results,
determines nothing is broken
and calls you with results.
 

your
out-of-pocket:

$20

your
out-of-pocket:

$120

*Allowed benefit applies to deductible.