Hospital Choice Cost Sharing

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If you have a plan with the Hospital Choice Cost Sharing feature, knowing how it works will help you get the right care at the right price for you and avoid unexpected costs. That's because with Hospital Choice Cost Sharing, what you pay for certain services depends on where you choose to get care.

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Already understand how Hospital Choice Cost Sharing works? Get prepared with our Planning Guide.

This health plan option includes a tiered network feature called Hospital Choice Cost Sharing. As a member in this plan, you will pay different levels of cost share* (such as copayments and/or co-insurance) for certain services depending on the network* general hospital you choose to furnish those covered services. For most network* general hospitals, you will pay the lowest cost sharing level*. However, if you receive certain covered services from any of the network* general hospitals, you pay the highest cost sharing level*. A network* general hospital's cost sharing level may change from time to time. Overall changes to add another network* general hospital to the highest cost sharing level will happen no more than once each calendar year. For help in finding a network* general hospital for which you pay the lowest cost sharing level, check the most current provider directory for your health plan option or download a PDF printable network hospital list for 2012, a PDF printable network hospital list for 2013, or to access the provider search page.

* - For the PPO plan designs, the different levels of cost sharing apply to in-network benefit levels at preferred general hospitals.

Your plan has a new benefit for certain members with a serious health condition, such as cancer or cystic fibrosis. With this benefit, which is due to a change in Massachusetts' law, members who qualify can receive care at certain higher-cost facilities and pay a lower cost share for up to one year. This benefit only applies in the following situations. Choose the one that applies to you.