Health insurance helps protect you from the high costs of healthcare. It helps you pay for doctor visits, hospital stays, prescription drugs and important preventive care.
The percent of the cost you pay for covered services. For example, you pay 20 percent of the cost for a doctor's office visit or hospital stay. Your plan pays the other 80 percent. Not all plans include coinsurance.
A small, flat fee you pay for some covered care at the time of service (for example, $25 for an office visit). Some plans do not require a copay.
Covered costs:
Medical tests, office visits, treatments, supplies, medications and services your plan covers. To find out what your plan covers, log into the member site, call the number on the back of your ID card or check the contract in your member welcome kit.
The amount you pay for healthcare each year before your plan begins to pay.
Drug list:
A list of drugs your plan covers. If you fill a prescription for a drug your plan doesn’t cover, you’ll pay the full cost. This cost will not count toward your deductible or out-of-pocket maximum. How to understand prescription drug benefits.
Before-tax contributions you make to an HSA account. You can use HSA funds to pay for some covered healthcare costs.
The hospitals, doctors, pharmacies and healthcare professionals that sign a contract with a health plan to provide care or prescription drugs for its members. These are also known as participating or in-network providers. To get the most coverage, you receive care from providers in your health plan network and pharmacies in your plan’s pharmacy network.
Some providers or pharmacies may not be in a plan’s networks. Providers or pharmacies in one network may not be in another network.
Some plans have a focused network. A focused network means that only certain providers or pharmacies participate in the plan’s provider or pharmacy networks.
If you visit a provider or a location that is not in the plan network, you will pay more for your care. If you get a drug from a pharmacy that's not in the plan network, you will pay more, or even the full cost for your drug. These out-of-network costs do not count toward your in-network cost-sharing (for example, your deductible and out-of-pocket maximum).
The most you could pay each year for covered services you receive in network.
The monthly amount you pay for your health plan. Usually, a lower premium comes with a higher deductible and out-of-pocket maximum.
See more health insurance definitions in the glossary.
Your costs in this example
How it works
Total amount you'd pay in this example:
Questions about health plans?
Call 1-855-571-4406
This is general information about how plan benefits work. Review the Summary of Benefits and Coverage and your specific health plan benefit booklet for information about how your plan works.
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 healthcare costs if your provider is out of your network or does not have a contract with Blue Cross (this is called a non-participating 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.
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