Health insurance doesn’t have to be confusing. We believe educating our members about their benefits as well as the health care delivery system in general can help make understanding health insurance easy. The more you understand about insurance, the better you will become at using it wisely — something that will save you time and money.
The level of coverage you select is designated by a metallic tier. The metallic tier will determine your premiums, the amount of cost-sharing, and the way you access covered services.
Plans currently offered through this site are called Preferred Provider Organizations, or PPOs. These are ideal plans if you want the freedom to manage your own care without referrals. With a PPO, you can get covered services from either in- or out-of-network. Just make an appointment and show your card when you check in. For the lowest out-of-pocket cost, be sure to choose an in-network doctor.
Visit our member engagement site to get personal benefits information and learn more about all the tools and resources available to members.
Health insurers negotiate fees and sign agreements with health care providers and facilities, creating a network of providers. Providers that are part of these agreements are considered in-network for members. Generally speaking, members pay less at these in-network facilities in the form of lower copayments and deductibles.
Providers and facilities that do not have a contract with a health insurer are considered out-of-network. Services at out-of-network providers and facilities may be more expensive and may not be covered through the health plan.
This is the maximum amount that you will have to pay under your plan. Any care for covered services you receive from in-network providers after you meet your out-of-pocket maximum will be covered 100 percent.
A deductible is the amount you pay before your health plan starts paying for covered services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for the services you receive. Once you have paid this amount, your insurance will begin to pay a portion or all of your health care costs up to the out of pocket maximum, depending on the plan. If you use a participating provider, your costs are based on our discounted rate.
Some plans require you to pay a percentage of your medical costs, or coinsurance (for example, Independence Blue Cross will pay 80 percent of the cost for services, you will pay 20 percent). If you use a participating provider, your costs are based on our discounted rate.
Also called a copay, it’s a set dollar amount you pay for a covered health service. For example, if you have a $15 copay for a doctor’s visit, you simply pay $15 and Independence Blue Cross covers the rest if you use an in-network provider.
Generic drugs have the same active ingredients as their brand-name drug counterparts. They usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.
A brand-name drug is a patented, FDA-approved drug usually produced by a single manufacturer with a product name under which the drug is advertised and sold. Newer drugs are usually available only as brand-name drugs. A brand-name drug may have a generic equivalent after the original patent expires.
