| Type of Plan |
Advantages |
Other Considerations |
Available Plans |
HMO
Health Maintenance Organization
|
| • |
Usually the least expensive choice |
| • |
Your PCP and providers handle the paperwork |
| • |
Copayments are usually known in advance. (Deductibles and/or coinsurance may apply in some plans.) |
|
| • |
With BlueChoice HMO, visits to a specialist usually require a referral from your PCP |
| • |
With BlueChoice HMO Open Access, no referrals from your PCP are required to see a specialist |
| • |
Very limited coverage out of the HMO's service area |
| • |
HMOs have a smaller network of providers than PPO or Traditional Indemnity plans |
| • |
Seeing an out-of-network provider usually means you will pay the entire cost |
|
|
Point of Service and
Opt-Out
Combines the features of managed care with out-of-network benefits
|
| • |
Includes benefits of an HMO and access to out-of-network providers |
| • |
When you use your PCP to coordinate care, you'll pay the lowest cost and they'll handle the paperwork |
| • |
Copayments for in-network services are known in advance. (Deductibles may apply in some plans.) |
|
| • |
More expensive than an HMO (but usually less expensive than a PPO) |
| • |
Using out-of-network providers will cost you more |
| • |
Coverage for out-of-area services will vary; check the plan carefully to understand costs |
|
|
Preferred Provider Organization
The health plan has negotiated rates with a network of providers.
|
| • |
Flexible |
| • |
Large choice of providers |
| • |
No referrals required |
| • |
You are not required to choose a PCP |
| • |
Preferred Providers will usually handle paperwork for you |
| • |
Coverage for out-of-area services is usually included; check the plan carefully to understand availability and costs |
|
| • |
Usually more expensive than an HMO or POS plan |
| • |
Many services will require that you pay a deductible and coinsurance |
| • |
Using out-of-network providers will cost you more |
|
|
Indemnity
Also called "comprehensive" or "fee for service" coverage |
| • |
Very flexible |
| • |
Largest choice of providers |
| • |
No referrals required |
| • |
You are not required to choose a PCP |
| • |
Participating providers usually accept the allowed benefit and can save you money |
| • |
Coverage for out-of-area services is usually included; check the plan carefully to understand availability and costs |
|
| • |
Offered less often than other plans |
| • |
Usually more expensive than other plans |
| • |
You may have to file your own claims if your provider does not participate with the plan |
| • |
If your provider does not accept the allowed benefit you may be responsible for all additional charges |
| • |
Deductible and coinsurance usually applies |
|
|
|
BlueFund Consumer Directed Health Plans
Combines a PPO with an employer-funded Health Reimbursement Arrangement (HRA), or an employer and/or employee-funded Health Savings Account (HSA).
|
| • |
Same flexibility and advantages as traditional PPOs |
| • |
Freedom to select any doctor |
| • |
Full coverage for routine preventive care when using in-network providers |
| • |
Members can use money in HRA/HSA for out-of-pocket health related expenses. |
| • |
Unspent HRA/HSA funds roll over to next year in members' medical funding account |
|
| • |
Online tools help keep track of medical funding account balance |
| • |
No claims to fill out for in-network services and out-of-network services by participating providers |
| • |
Large national network of preferred and participating providers through BlueCard program |
| • |
Value-added programs for non-covered services such as fitness memberships, laser vision correction and more |
|
|
