bcbsri product overview · bcbsri product overview. page 2 of 4 bluesolutions no covers basic...
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ProductPCP/ReferralRequired
Description NetworkCoverage OutofNetworkCoverage
CommercialMarketSegmentBasicBlue No Thisplancoversofficevisitsandmostgenericdrugs,beforethedeductible
ismet,whilealsoprovidingcomprehensivecoverageaftersatisfyingthedeductible.
BlueCardNationalPPO-Nationalnetworkwithover90%ofdoctorsandhospitalsacrossall50states.
Notcovered,exceptforurgentoremergencycare.
BlueCHiP Yes Thisplancoversofficevisitsandmostprescriptiondrugsbeforethedeductibleismetwhile,alsoprovidingwide-rangingcoverage,aftersatisfyingthedeductible.-Thisplanrequiresthatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
LocalRhodeIslandnetwork Offeredwithorwithoutout-of-networkcoverage.
BlueCHiPAdvance Yes Aprimarycare-basedplanwithuniqueaccesstocoordinatedandcomprehensivecare.-Thisplanrequiresthatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
LocalRhodeIslandnetwork-PreferrednetworkthroughIntegra
Yes
BlueCHiPDirectAdvance Yes Thisplancoversofficevisitsandmostprescriptiondrugsbeforethedeductibleismetwhilealsoprovidingwide-rangingcoverageaftersatisfyingthedeductible.-Thisplanrequiresthatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
TailoredRhodeIslandnetwork-CenteredaroundLifespanfacilitiesandaffiliatedproviders
Notcoveredexceptforurgentoremergencycare.
BCBSRIProductOverview
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BlueSolutions No Coversbasicservices,likeofficevisitsandmostgenericdrugs,beforethedeductible.
BlueCardNationalPPO-Nationalnetworkwithover90%ofdoctorsandhospitalsacrossall50states.
Yes
BlueSolutionsSelectRI No Accesstoatailorednetworkofhigh-qualitydoctors,hospitals,andlabsinRhodeIsland.
LocalRhodeIslandNetwork-Tierednetworkforcertainservices.
Yes
BlueChoiceNewEngland Yes Thisplanofferstraditionalbenefitswithaddedbenefitsformembersmanagingchronicconditions.-Thisplanrequiresthatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
RegionalBlueNetworkincludingConnecticut,Massachusetts,Maine,NewHampshireandRhodeIsland.
Yes
HealthMateCoasttoCoast No Thisplanofferstraditionalhealthbenefitswithpredictablefixed-dollarcopaymentsorcoinsuranceformanyservices.
BlueCardNationalPPO-Nationalnetworkwithover90%ofdoctorsandhospitalsacrossall50states.
Yes
NetworkBlueNewEngland Yes Thisplanofferstraditionalbenefitswithaddedbenefitsformembersmanagingchronicconditions.-Thisplanrequiresthatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
RegionalBlueNetwork,includingConnecticut,Massachusetts,Maine,NewHampshireandRhodeIsland.
Notcoveredexceptforurgentoremergencycare.
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VantageBlue No Thisplanofferstraditionalbenefitswithaddedincentivesforhealthyliving.Thisplanempowersmemberswithmanypreventivebenefitsthatmakeiteasiertobehealthierandactivelyengagedintheirhealthcare.
BlueCardNationalPPO-Nationalnetworkwithover90%ofdoctorsandhospitalsacrossall50states.
Yes
VantageBlueSelect No Aprimarycare-basedplanwithuniqueaccesstocoordinatedandcomprehensivecare.
LocalRhodeIslandNetwork-PreferrednetworkthroughCharterCARE
Yes
VantageBlueSelectRI No Aninnovativenetworkoptionthatprovidessavings,whenmembersusedoctorsandfreestandingfacilitiesinourpreferredlocalnetwork.Membersstillenjoynationwidenetworkaccessandenhancedbenefits.
LocalRhodeIslandNetwork-Tierednetworkforcertainservices
Yes
SeniorMarketSegmentBlueCHiPforMedicareAdvance Yes
Aprimarycare-basedplanwithuniqueaccesstocoordinatedandcomprehensivecare.Thisplanoffersasystemofcarenetworkthatiscoordinatedbythemember'sprimarycareprovider.-This planrequiresmemberstoselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
SelectedsystemofcarenetworkofPCPs,skillednursingfacilitiesandhospitals.TheremainderofthenetworkistheentireBlueCHiPforMedicarenetwork.
Notcovered,exceptforurgentoremergencycare.
BlueCHiPforMedicareHMOPlans(Core,StandardwithDrugs,Plus)
Yes TheseplansofferstandardMedicarebenefitswithaddedsupplementalbenefitsaboveandbeyondwhatfederalMedicarecovers.Eachplanoffersavaryingdegreeofcopays/conisurancesandpremiumstomeeteachmember'sneeds.BlueCHiPforMedicareCoredoesnotofferPartDdrugs.-Theseplansrequirethatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
StandardBlueCHiPforMedicarenetworkwithnopointofservice/out-of-networkcoverage.
Notcovered,exceptforurgentoremergencycare.
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BlueCHiPforMedicareHMO-POSPlans(Value,Extra,Preferred)
Yes TheseplansofferstandardMedicarebenefitswithaddedsupplementalbenefitsaboveandbeyondwhatfederalMedicarecovers.Eachplanoffersavaryingdegreeofcopays/conisurancesandpremiumstomeeteachmember'sneeds.Theseplansalsohaveapointofservice(POS)optiononmostbenefitswithintheplan.-Theseplansrequirethatmembersselectaprimarycareprovider,whowillcoordinatetheircareusingreferrals.
StandardBlueCHiPforMedicarenetworkwithpointofservice/out-of-networkcoverageonmanybenefits.
Yes,onmostbenefits.
BlueCHiPforMedicareGroup HMOPlan(Plus) No ThisplansoffersstandardMedicarebenefitswithaddedsupplementalbenefitaboveandbeyondwhatfederalMedicarecovers.Thisplanoffersavaryingdegreeofcopays/coinsurancestomeeteachmember'sneeds.ThisplanincludesDentalandPartDdrugcoverageanddoesnotrequirememberstoselectaprimarycareproviderorreferrals.
StandardBlueCHiPforMedicarenetworkwithnopointofservice/out-of-networkcoverage.
Notcovered,exceptforurgentoremergencycare.
BlueCHiPforMedicareGroupHMO-POSPlans(Preferred,PreferredUnlimited,PreferredUnlimited2)
No TheseplansofferstandardMedicarebenefitswithaddedsupplementalbenefitaboveandbeyondwhatfederalMedicarecovers.Theseplansofferavaryingdegreeofcopays/coinsurancestomeeteachmember'sneedsalongwithapoint-of-service(POS)optiononmostbenefitswithintheplan.TheseplansincludeDentalandPartDdrugcoverageanddo notrequirememberstoselectaprimarycareproviderorreferrals.
StandardBlueCHiPforMedicarenetworkwithpointofservice/out-of-networkcoverageonmanybenefits.
Yes,onmostbenefits.
Plan65 No MedicareSupplementplan FederalMedicarenetwork Yes,aslongastheprovideracceptsMedicareAssignment.
Plan65Select No MedicareSupplementplan FederalMedicarenetworkwiththeexceptionofhospitals,whichisthelocalPlan65SelectHospitalnetwork.
Yes,aslongastheprovideracceptsMedicareAssignment.HospitalsoutsidethePlan65networkarenotcovered,exceptforurgentoremergencycare.
FIRSTNAMEMIDLASTNAMEMEMBERIDRxBIN 610455Issuer 80840RxPCN BCRIMAGRxGrp BCRIMACMS H4152 817
BlueCHiP for MedicareGroup Plus (HMO)
PCP: PCPFIRSTPCPLAST
PCP PHONE: 999-999-9999
Issued 01/01/18
PCMH VisitNon-PCMH VisitSpecialist VisitEmergency Room
$0$10$30$65
1316
-MA
2A16
IC(S
) 30
2-00
-A-0
0000
MC
A-04
85--
M(M
EM)D
(Y)V
()
2018
0110
B04
Sh: 0
Bin
1J0
C9
Env
[1] C
Sets
1 o
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FIRSTNAMEMIDLASTNAMEMEMBERIDRxBIN 610455Issuer 80840RxPCN BCRIMAGRxGrp BCRIMACMS H4152 815
BlueCHiP for MedicareGroup Preferred Unlimited
(HMO-POS)PCP: PCPFIRST
PCPLASTPCP PHONE: 999-999-9999
Issued 01/01/18
PCMH VisitNon-PCMH VisitSpecialist VisitEmergency Room
$0$5$25$65
1316
-MA
2A16
IC(S
) 36
0-00
-A-0
0000
MC
A-06
93--
M(M
EM)D
(Y)V
()
2018
0110
B04
Sh: 0
Bin
1J0
C9
Env
[1] C
Sets
12
of 1
7