Your primary care provider (PCP) directs most of your care and referrals to other doctors. This plan covers office visits and generic drugs before the deductible, and it uses our local RI network, which includes all Rhode Island hospitals.
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
- A network that includes all RI hospitals, about 1,400 PCPs, and about 3,300 specialists
- Full coverage for programs to stop smoking, lose weight, and manage conditions like asthma and diabetes
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.
$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 when you receive the services in-network.
Find a doctor and see the cost
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.