Essential Blue: Understanding Provider Tiers and Choosing a PCP

Essential Blue is an HMO Blue^® health plan with a tiered network of providers and two levels of cost sharing. With this plan, you must choose a primary care provider (PCP), who will manage all your care and refer you to a specialist when you need one. The cost that you pay for covered services is based on which tier your PCP is in.

• You pay lower copayments and co-insurance by choosing a PCP in the Enhanced Benefit Tier.
• You pay higher copayments and co-insurance by choosing a PCP in the Standard Benefit Tier.

How to Find a PCP
For lower out-of-pocket costs for all covered services where there are two levels of cost sharing, choose a PCP in the Enhanced Benefit Tier. To do so, you can:

• use our online search function by selecting Essential Blue Network from the network drop down menu
• consult the Essential Blue Provider Directory or view a PDF file of the Enhanced Benefit Tier Primary Care Providers (PCPs) section within the directory
• call our Provider Selection Service at 1-800-821-1388

How Tiers Are Determined
In order to participate in Blue Cross Blue Shield of Massachusetts' Enhanced Benefit Tier, PCPs were affiliated with provider groups that:

• are considered an integrated delivery system
• have achieved a high level of cost efficiency
• have a large geographic reach
• have the capacity for membership growth or can adjust delivery to serve new members effectively
• or are required for geographic access coverage

Learn more about Essential Blue plans.