Your choice between the most common types of health insurance plans may affect which doctors or specialists are in your network.
Provider networks are different for HMO and PPO plans. Both HMOs and PPOs can be “open access”. This means you can choose to see an out-of-network provider without a referral, but you’ll pay less when you get care from a doctor in the HMO or PPO network.
With traditional HMOs, you need to use a specific provider network and choose a primary care doctor. Some HMOs may require a referral from your primary care doctor before you can see a specialist.
With a PPO, you have a network of preferred providers. You are typically able to choose any doctor or specialist without a referral if they are in the PPO network.
Blue Cross offers open access PPO plans to employer groups.
Blue Plus is a licensed nonprofit HMO. It is an affiliate of Blue Cross and Blue Shield of Minnesota. Blue Plus HMO plans are available to people who qualify for Minnesota Medical Assistance (Medicaid). These plans can help you pay for healthcare if you have limited income or a disability.
Blue Plus members in a Medical Assistance plan must choose a doctor from the Blue Plus network, or one will be assigned. These Blue Plus plans are open access, which means members can select any primary care physician or specialist in the network and do not need a referral. In some instances, out-of-network care is allowed.
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.