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

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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

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