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Page 1 of 4 Product PCP/ Referral Required Description Network Coverage Out of Network Coverage Commercial Market Segment BasicBlue No This plan covers office visits and most generic drugs, before the deductible is met, while also providing comprehensive coverage after satisfying the deductible. BlueCard National PPO - National network with over 90% of doctors and hospitals across all 50 states. Not covered, except for urgent or emergency care. BlueCHiP Yes This plan covers office visits and most prescription drugs before the deductible is met while, also providing wide-ranging coverage, after satisfying the deductible. - This plan requires that members select a primary care provider, who will coordinate their care using referrals. Local Rhode Island network Offered with or without out-of- network coverage. BlueCHiP Advance Yes A primary care-based plan with unique access to coordinated and comprehensive care. - This plan requires that members select a primary care provider, who will coordinate their care using referrals. Local Rhode Island network - Preferred network through Integra Yes BlueCHiP Direct Advance Yes This plan covers office visits and most prescription drugs before the deductible is met while also providing wide-ranging coverage after satisfying the deductible. - This plan requires that members select a primary care provider, who will coordinate their care using referrals. Tailored Rhode Island network -Centered around Lifespan facilities and affiliated providers Not covered except for urgent or emergency care. BCBSRI Product Overview

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Page 1: BCBSRI Product Overview · BCBSRI Product Overview. Page 2 of 4 BlueSolutions No Covers basic services, like office visits and most generic drugs, before the deductible. BlueCard

Page1of4

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

Page 2: BCBSRI Product Overview · BCBSRI Product Overview. Page 2 of 4 BlueSolutions No Covers basic services, like office visits and most generic drugs, before the deductible. BlueCard

Page2of4

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.

Page 3: BCBSRI Product Overview · BCBSRI Product Overview. Page 2 of 4 BlueSolutions No Covers basic services, like office visits and most generic drugs, before the deductible. BlueCard

Page3of4

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.

Page 4: BCBSRI Product Overview · BCBSRI Product Overview. Page 2 of 4 BlueSolutions No Covers basic services, like office visits and most generic drugs, before the deductible. BlueCard

Page4of4

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

1316

-MA

2A16

IC(S

) 36

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