A few highlights of your plan:
- A primary care provider (PCP) who is your “regular” doctor and provides referrals for specialists, tests, and some other services
- $0 copays for visits to your PCP if they belong to a patient-centered medical home, or PCMH (We explain these below.)
- A network that includes all RI hospitals, 1,550 PCPs, and 3,800 specialists
Do you need a referral?
Your healthcare in this plan is based on referrals from your PCP, but some types of care, like emergency and mental health services, don’t require a referral.
PCP and PCMH explained
Think of a primary care provider (PCP) as your regular doctor, the one you see for a checkup and when you have a medical concern. When they work with a patient-centered medical home (PCMH), they lead an entire team to help you.
Earn rewards just for making healthy choices
Our wellness program will keep you stepping, tracking, and having fun while improving your health.
See a doctor online
You can use Doctors Online when you can’t get to your own doctor’s office. Set up your account now so it's ready for you when you need it.
Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of Blue Cross & Blue Shield of Rhode Island.
$0 for prevention
You can make a big difference in your health by getting the preventive care you need. Annual physicals, routine tests, and many more services may cost you nothing out-of-pocket.
Know the basics
The amount you pay before your health plan starts to pay for certain medical bills. It resets every calendar year or plan year.
A specific dollar amount you pay when you get healthcare. Example: A doctor might charge $100 for a visit. If your health insurance has a $20 copay, you would pay the doctor $20 and your insurance would pay the doctor $80.
The percentage of the total medical bill that you have to pay after you’ve met your deductible. For example, some plans have a 20% coinsurance charge for physical therapy. So if the total bill is $100, the coinsurance would be $20.
The maximum amount you would pay out-of-pocket for covered healthcare services each year, including deductible, copays, and coinsurance. After the out-of-pocket is met, in-network covered services are paid at 100% by Blue Cross & Blue Shield of Rhode Island.
An order from your primary care provider (PCP) for you to receive care from another doctor, specialist, or medical facility.