Hospital Choice Cost Sharing Planning Guide

Research Your Doctors' Hospital Affiliations
A doctor's hospitalAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. affiliations are the hospitals where he or she can provide care (also known as hospital privileges). It's important to know your doctor's hospital affiliation before you need care because your costs will be based on the hospital you choose.

And when you're choosing new doctors, be sure to check their hospital affiliation before you make an appointment.

Primary Care Provider (PCP)
The hospital(s) where your PCPAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. is affiliated may affect where he or she will referIf a PCP determines that an individual requires specialized care, the PCP may "refer" that person to an appropriate specialist. A referral is often required by a managed care plan before the plan will cover certain services. you for specialist care. This is because it's easier for him or her to coordinate your care when you are at a hospital where your PCP is affiliated. Check your PCP's hospital affiliation and talk to him or her about where you would like to be referred.

Specialists
When you need specialty care, you should check where your specialist is affiliated before getting care. This is because if your specialist is going to send you to a hospital for care, your costs for that care will be based on the hospital where you receive your care.

How to Check Your Doctor's Hospital Affiliation

Once you know a doctor's hospital affiliation, check if the hospital or affiliated location is Lower or Higher Cost Share.

Hospital	Download 2012 List	Download 2013 List		|	Search for Hospital	|	View Map
Freestanding Labs and Imaging	Download List			|	Search for Facility

Understand Services & Costs
With Hospital Choice Cost Sharing, you can control what you pay for certain types of care by choosing Lower Cost Share hospitals, freestanding labs, and imaging centers. Use the Service Cost Comparison tool below to understand your cost differences.

Our Learn, Plan, Save Approach helps you find lower-cost, high-quality hospitals, free standing labs and imaging centers.

Categories of Service
Hospital Choice Cost Sharing only applies to six categories of service.

* Preventive care is provided at Lower Cost Share level if you have any cost sharing for preventive services.

Service Cost Comparison Tool
Select your plan and service to see the difference in costs at Higher Cost hospitalsAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. , Lower Cost hospitals, freestanding labs, and imaging centers.^**

Step 1: Select Your Plan

Select your plan Access Blue Basic $2000 HMO Blue $2000 Deductible HMO Blue NE $1000 Deductible HMO Blue NE $500 Deductible HMO Blue Premier Value HMO Blue NE Premier Value with Co-Insurance HMO Blue NE Value Plus HMO Blue NE Enhanced Value Preferred Blue PPO $1000 Deductible Preferred Blue PPO $2000 Deductible Preferred Blue PPO Basic 2000

Step 2: Select Your Service

Select your Service Inpatient Care Outpatient Day Surgery Outpatient Diagnostic High-Tech Radiology Outpatient Diagnostic X-Rays and Other Imaging Tests Outpatient Diagnostic Lab Tests Outpatient Physical, Occupational & Speech Therapy

Hospital Choice Cost Sharing (HCCS)		Deductible Amount**	HCCS Copay or Co-insurance**	Total
Higher Cost Share Hospital (High)
Lower Cost Share Hospital (Low)
Freestanding Labs & Imaging Center (Low)

Check Your Hospital or Facility or Find A Lower Cost Hospital or Facility

Hospital	Download List    |    Search for Hospital    |    View Map
Freestanding Labs and Imaging	Download List   |    Search for Facility

Care at in-network freestanding labs and imaging centers, such as Quest Diagnostics or Shields MRI, is always provided at the Lower Cost Share level. Freestanding labs and imaging centers, sometimes referred to as non-hospital based facilities, are often a convenient, economical alternative to hospitals for services like lab work, MRIs, and outpatient surgery.

Emergency Care
In an emergencyAn accident or sudden illness that an ordinary layperson believes needs to be treated right away or it could result in loss of life, serious medical complications, or permanent disability. Important: If you believe that you are having a life-threatening medical emergency, call 911 or your local emergency number and seek medical help immediately. , you should go directly to the nearest medical facility or call 911. You'll pay an emergency room copaymentThe amount that a plan member must pay the provider at the time of service. Also called a copay, this amount varies depending on the specifics of a given health plan contract. per visit for emergency room services. Check your summary of benefits for your emergency room copayment amount. This copayment is waived if you are admitted to the hospital or for an observation stay. The amount you will pay for care during an emergency is the same regardless of the hospital you visit.

** Your actual costs and plan design may be different from the illustrations provided here. Be sure to check your benefit documents to see your actual out-of-pocket costs.

Because your choice of hospitalAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. can affect your wallet, you should be an active partner with your doctor in choosing where you get care.

You can choose to go to Higher Cost Share hospitals¹, but you will pay more for certain categories of service. If you choose Lower Cost Share hospitals, freestanding labs, and imaging centers, you will pay the lowest cost for your care.

Before Your Next Doctor's Visit

• Check your doctor's hospital affiliation, so you know where he or she would usually send you for care.

• Take time to review our helpful brochure on talking to your doctor about your Hospital Choice Cost Sharing benefits, so you know where he or she would usually send you for care.

When You Visit Your Doctor

• Let your doctor know that you will pay more if you receive certain categories of service at Higher Cost Share hospitals. You can bring along our Talking to Your Doctor About Hospital Choice Cost Sharing brochure to make the conversation easier.
• Share the categories of service and list of hospitals (for care in 2012), list of hospitals (for care in 2013), freestanding labs, and imaging centers with your doctor so you can review your options for care together.

To Avoid a Referral to a Higher Cost Share Hospital

1. About Higher Cost Share hospitals: Some Higher Cost hospitals contract with Lower Cost Share providers, such as Quest Diagnostics or Shields MRI, to provide services within the hospital. You can call the Higher Cost Share hospital to find out if certain services (e.g., labs, MRIs) are billed by a Lower Cost Share provider. If they do, you'll be able to get care for the lower cost.