Understand Your Costs
Within the Blue Options network, hospitals and groups of primary care providers (PCPs) are grouped into three benefits tiers.
What you pay for care is based on the benefits tier* of the PCP or hospital where you receive care.
|Benefits Tier||Your Cost|
|Enhanced||$ — lowest cost|
|Standard||$$ — moderate cost|
|Basic||$$$ — highest cost|
$ — lowest cost
$$ — moderate cost
$$$ — highest cost
Calculate Your Costs
You can see examples of what your costs would be by using our Tier Savings Calculator Tool. You will need to know the name of your plan to use the tool. You can find this by looking at your benefit summary or checking the front of your member ID card.
In an emergency, you should go directly to the nearest medical facility or call 911. You'll pay an emergency room copayment 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, regardless of the hospital you visit.
* Note: PCPs were measured based on their HMO / POS patients as part of their provider group, and hospitals were measured based on their individual facility performance. Provider groups can be composed of an individual provider, or a number of providers who practice together. Tier placement is based on cost and quality benchmarks where measurable data is available. Providers without sufficient data for either cost or quality are placed in the Standard Benefits Tier. If you would like more information on the benefits tiers, visit the Choosing Doctors & Hospitals section.