Health plans can be complicated, so we've created this section to help simplify it.
What does "health plan" mean?
It's insurance that pays for medical bills, hospital bills, and typically prescription drug expenses.
Why do you need it?
- It helps you pay for everyday medical expenses.
- You'll pay lower prices for health care because we negotiate with doctors and hospitals to get lower prices for our members.
- It protects you and your family financially in the event of serious illness or injury.
- Preventive care is less expensive and in some cases covered at 100%.
- If you wait until you or a family member is ill to purchase health insurance, you may be subject to pre-existing conditions.
How do you get it?
- Group Insurance - offered by employers/organizations
When you get membership through an organization/employer, you usually will pay less in monthly rates than an individual. However, in some cases you may be responsible for paying the entire monthly rate.
- Individual Insurance - individual coverage purchased directly from insurance company
You are responsible for paying the entire monthly rate, it isn't shared with an organization/employer.
What are the types of health plans?
There are just a few types of health plans for you to chose from:
- HMO (Health Maintenance Organization)
- PPO (Preferred Provider Organization)
- POS (Point-of-Service)
- High-Deductible (HSA compatible plans)
In addition to your monthly subscription fee, known as "rate," your plan will consist of one, or a combination of the following out-of-pocket expenses:
- Copayment or co-pay: the flat fee you pay for each health care service or prescription
- Coinsurance: the share of the bill for a health service covered between you and us.
- Deductible: specified yearly amount you must pay before we (BCBSVT) starting paying all, or a portion, of your healthcare costs. Deductibles vary by plan.
What plan is best for you?
There is no "best" plan, it truly depends on what your needs and preferences are. What might work for one person, may not for another.
For one person, having complete freedom to choose doctors and hospitals, even if it costs more might be the most important feature. While for another, holding down costs is the most important, even if it means limiting some of their choices in doctors and hospitals.