Network Blue New England

BCBS Network Blue New England is a health maintenance organization (HMO).  The amounts you pay for care (your copays) will depend on the primary care physician (PCP) you choose to coordinate your care.

When you join this plan, you agree to receive all your health care, except emergency care, within the plan network, coordinated or referred by a PCP.

You may name:
• A PCP affiliated with Boston Medical Center (BMC); your copays will be less, even if your PCP refers you to a specialist who is not affiliated with BMC
• A BCBS Network Blue New England PCP who is not affiliated with BMC; your copays will be higher, even if your PCP refers you to a BMC specialist

There are no deductibles in this plan and there is no out-of-network benefit level.
Here is a brief example of how the plan operates depending on your choice of PCP.

Covered Service

BMC PCP and Referrals

Non-BMC PCP and Referrals

Inpatient hospital including
maternity
You pay nothing You pay a $200 copay per admission
Office visits with PCP You pay a $15 copay You pay a $30 copay
Office visits with Specialist You pay a $15 copay You pay a $40 copay
Preventive care You pay nothing  You pay nothing
Emergency room  You pay a $100 copay;
waived if admitted
 You pay a $100 copay;
waived if admitted
Hi-tech imaging You pay a $25 copay You pay a $50 copay
Outpatient surgery You pay nothing You pay a $100 copay per admission
Outpatient rehabilitation therapies You pay a $15 copay;
You pay nothing at Sargent College facilities
You pay a $40 copay;
You pay nothing at Sargent College facilities

Prescription drug coverage is provided through Express Scripts.