Getting care

Some health plans require a referral from your primary care provider (PCP) before you can see a specialist. A referral authorizes you to see a specialist for diagnosis or treatment of a medical condition. Without the referral, your care may not be covered, or you may be required to pay more for services. To see if a referral is required on your health plan, call the customer service number on the back of your member ID card.

Preventive screenings look for health conditions or diseases before there are any signs or symptoms. Diagnostic tests are run when your doctor knows you have a health problem but needs to know the cause or extent. Most preventive screenings are covered at little or no cost to you. If you need a diagnostic test, you will likely pay for a portion of the test according to your health plan benefits (deductible, copay, coinsurance, etc.).

A premium is the fixed amount you pay periodically for your health insurance (health plan) plan coverage. Those with coverage through their employer pay a portion of their premium through payroll deduction. 

A deductible is the amount you pay for healthcare before your health plan begins to make payments. For example, if your deductible is $1,000, your health plan will begin paying once you’ve paid $1,000 toward allowable (not billed) charges. An allowable charge is the amount your health plan agrees to pay for a particular healthcare service. The amount reflected on a healthcare provider’s bill may be more, but your deductible is based on what’s allowed. You may have a deductible for each person on your policy and one for your family. 

Copayments (copays) are a fixed amount you pay, usually at the time of a medical service. Copays are separate from, and do not count as part of, your deductible. However, they do count toward your out-of-pocket maximum, which can help if you have high medical expenses during a calendar year. Your copay can vary, depending on the type of service you receive. You also may have a copay when you get a prescription filled. 

Coinsurance is the percentage of the cost you are responsible to pay for healthcare services after your deductible has been met. For example, you may pay 20% for a service, and your insurance may pay 80%. 

If you elected health plan benefits from your employer, your premium is deducted from your paycheck. Your employer is helping share the costs of healthcare by offering you a health plan as part of your employee benefits package.  

If you have purchased a health plan through the Health Insurance Marketplace, you can pay your premium online through Blueprint Portal or by calling the customer service number on the back of your member ID card. If you need additional help, there are a number of ways to get support from us.

A health savings account (HSA) is available to those enrolled in a high-deductible health plan (HDHP). It allows you to use pre-tax dollars for qualified medical expenses and can be invested in mutual funds. Funds never expire and can grow year-to-year. Contribution limits are determined by the IRS. Learn more about HSAs.

A flexible spending account (FSA) is available to those enrolled in employer sponsored health plans. It allows you to use pre-tax dollars for qualified medical expenses. Funds expire annually, so you must use the money you put into the account by the end of the year or lose it. Contribution limits are determined by the IRS.

You cannot contribute to both an HSA and an FSA. If you have health insurance through your employer, you may get a choice of which account you would like to use.