For people who want more flexibility and choice from their health care plan, our PPOA type of health plan with a network of providers who are "preferred", that is, a member can visit these preferred in-network physicians and don't need to choose a primary care physician. In some PPOs, members can also visit non-preferred, or out-of-network providers, but may have to pay a higher fee or copayment. plans are a great option. Our PPO plans offer the same reliable coverage you expect from Blue Cross Blue Shield of Massachusetts, but without the need for referralsIf 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. and more choice in doctors and 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. .
You'll get the best benefits if you choose providers in the nationwide networkA group of health care providers under contract with a managed care company within a specific geographic area. , however you can also choose to see providers outside the network for care.
Our PPO plans differ in cost and benefits, but no matter what plan you choose, it will have these features:
- You are not required to select a primary care provider (PCP)A provider, usually a family or general practitioner, internist, or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals, and other providers as necessary. Under some benefits plans, a referral by the primary care provider is required to obtain services from other providers. Each covered family member chooses his or her own PCP from the network's providers. .
- You don't need referrals from your PCP to see specialists
- Your care is covered when doctors and hospitals are in your plan network
Generally, our PPO plans cover these types of care:
- Inpatient and outpatient medical care
- Mental health/substance use
- Prescription drugA drug that has been approved by the Federal Food and Drug Administration as dispensable only with a licensed physician's prescription. benefits
- Preventive care with no out-of-pocketCopayments, deductibles, or fees paid members for health services or prescriptions. costs
To get the specifics of your plan, check your subscriber certificate or visit Member Central and click on the Using My Plan tab. Your member ID cardIdentification cards are provided to all participants for proper identification under their group health plan. ID card information helps providers verify patient eligibility for coverage. contains valuable information so it's important for you to know how to read your ID card. Watch our Managed Care video to learn more about your health plan.