See what your health plan covers

Looking for information about what’s covered by your health plan? Log in to the member site to see a summary of your benefits.

There are many types of health plans. To see your plan’s coverage information, log in or register on the member site or call customer service using the number on the back of your ID card.

You can also review the information below to help you find the answers you need.

Where can I find out what my health plan covers?

Your coverage information is available in two main documents:

Your benefits booklet is a more detailed descriptions of your benefits. This is sometimes also known as Evidence of Coverage or Summary Plan Description.
Summary of Benefits and Coverage is a high-level description of benefits in chart form.

You can find these documents in your plan enrollment materials or welcome kit, by logging in to the member site or by calling the customer service number on the back of your member ID card.

How can I learn about next year’s plan coverage?

In most cases, new health plan information for the next year is available in the fall.

Do I need prior authorization?

Blue Cross sometimes requires a prior authorization before covering certain treatments or procedures. Learn why, when and how prior authorization works. For help, call the customer service number on the back of your member ID card.

How can I find out about costs?

For most medical care, the cost you pay depends on many factors:

Is the doctor, hospital and/or clinic you use in your plan network?*
Is the pharmacy in your plan network?
Is the service, lab test or prescription drug covered by your plan?
Is the service or test medically necessary? Do you need prior authorization?
Have you met your deductible? Do you have a copay or coinsurance?
Is the service preventive care, or to diagnose or treat an illness?
How does where a service is performed affect costs?

It’s important to understand how you and insurance pay for your healthcare. Knowing how your health plan works will give you a better idea about the costs you may need to pay for a medical service.

You can also use our member app's Medical Cost Estimator (for those in the Aware network) and Drug Cost Estimator (for those with drug benefits administered by Prime Therapeutics) to get cost estimates.

More about what’s covered

*It’s up to you to always check if your provider is in your health plan network before you receive services. Not all providers are in every network. You may pay more or for all of your health care costs if your provider is out of your network or does not have a contract with Blue Cross (this is called a nonparticipating provider). You can verify if your provider is in your network by calling customer service at the number on the back of your member ID card.

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

This is general information about how plan benefits work. Review the Summary of Benefits and Coverage and your specific health plan benefits book for information about how your plan works.