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The best in coordinated care...
Our coordinated care product, BlueCHiP Coordinated Health Plan, offers members
the advantages of low out-of-pocket costs, complete coverage for
preventive care, more than 3,400 network providers and a personal
primary care physician to help guide them through the healthcare
system. When members access healthcare through their personal
physician, they receive compre-hensive coverage for all eligible
services, coordinated by a doctor they know and trust.
Access to care
- Members select a personal primary care physician who coordinates their healthcare.
- A growing provider network that has more than 1,160 personal physicians and 2,330 specialists.
Coverage
When provided, arranged or coordinated by the personal physician, most services are covered at 100%, including hospitalization, home care, diagnostic lab and x-ray, surgery and obstetrical care.
- Office visits and preventive services, including routine pediatric care and adult routine physicals are covered in full after a $10 copayment/$20 copayment for specialist.
- Emergency care is covered in full after a $25 copayment (waived if admitted).
- No referral required for chiropractic medicine, annual eye or GYN exams.
Mental Health/Chemical Dependency Services
Inpatient services are covered at 100% and outpatient services have a $10 copayment. All services must be arranged or pre-authorized by our Behavioral Health Administrator prior to receiving treatment. Annual limitations apply.
Flex Rider
Members may visit non-network or self refer to non-network providers and receive
80% coverage (based on the BlueCHiP Coordinated Health Plan allowance),
after deductible* and any applicable copayments are met. Benefit
is increased to 100% after member reaches $3,000 out-of-pocket maximum
(or $6,000 for family).
Out-of-area Claims Service
AWAY FROM HOME CARE, our out-of-area care program, gives members a toll free number
for instant referral to a hospital or facility nearby, where emergency
care is covered in full at any time through HMO USA. There are no
claims or up front payments at any member facility. If a member
does not use the toll free referral service, his or her primary
care physician and/or the member should notify Blue Cross &
Blue Shield of Rhode Island as soon as possible but no later than
forty-eight (48) hours after the provision of emergency services.
Prescription Coverage
Our pharmacy network allows members to have prescriptions filled at any Brooks
or CVS pharmacy in the service area or any one of our 40 independent
pharmacies listed in the provider directory. Prescription drugs
filled at an out-of-network pharmacy must be paid for by the member
and then submitted to us for reimbursement.
* $250/member, $500/combined family per calendar year; counts toward out-of-pocket maximum.
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