Your plan revolves around
your unique health needs.
Our networks in
England, and beyond offer
access to the best
doctors, hospitals, and
We provide leading-edge
solutions to improve your
health and well-being.
With over 80 years of
dedicated service, we've
earned our reputation as
America’s #1 health brand.
Our HMO Blue New England plans give you access to New England's best doctors and hospitals. With an HMO, you're:
Our PPO plans offer greater flexibility and a wider network of doctors and hospitals to choose from. With a PPO plan, you are:
|Question||HMO BLUE NEW ENGLAND||PPO|
|Where can I be seen?||You can see network providers within Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.||You can see providers in our national network.|
|Is it covered if I go out of my network?||Only urgent and emergency care are covered out of network.||Yes, but you pay more of the cost and all amounts over allowed charges.|
|Do I need a PCP?||Yes, you're required to select a PCP.||No, you aren't required to select a PCP.|
|Do I need referrals to see specialists?||Yes, your PCP must refer you to specialists within your network.||No, you don't need a referral to see a specialist.|
|Deductible||The amount you pay before your insurance begins picking up any of the costs for certain services.|
|Co-insurance||A percentage of the cost a doctor or hospital charges that you're required to pay.|
|Copayments||The costs you're required to pay for certain services or prescription medications. Your copayments will vary depending on your plan and the type of service or medication; however, in some instances, care may not be covered.|
|Primary Care Provider||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.|
|In-Network Provider||Any health care provider (doctor, hospital, etc.) that belongs to a health plan's network. Using an in-network provider will usually cost members less in copayments or co-insurance.|
|Out-of-Network Provider||Any health care provider that doesn't belong to a health plan's network. Members can see out-of-network providers, but will pay significantly more for services.|
Preventive: You expect to primarily receive preventive care,
which is generally covered when received in network.
Both HMO and PPO plans cover preventive care when
received in network. (You may have to pay for services to
check on an existing issue or to diagnose a health concern.)
Occasional: You don't expect to receive
frequent medical care.
With an HMO: Referrals are needed.
Your PCP coordinates your care using in-network providers.
With a PPO: No referral is needed.
You have the flexibility to use out-of-network providers.
Frequent: You anticipate the need for
frequent medical care.
A PPO is more flexible. You and/or your family frequently
require medical care for chronic conditions, and you can see
specialists without a referral.
Pay less for my medical coverage out of my paycheck,
knowing I may be responsible for more in
out-of-pocket expenses when I need care.
Pay more for my medical coverage out of my paycheck
in return for set out-of-pocket costs when
I need care.
Typically, health plans that have higher premiums,
or cost per paycheck, offer lower deductibles.
If you expect to receive frequent care or have a
scheduled surgery in the next year, a lower deductible
may help offset the monthly costs.