0%
See if you're eligible
Find a doctor
Get fit with
GoalGetter®' apps
Keep your looks,
lose the smokes
Work out and save money
De-stress with yoga

The Plan

And for around $2151 per month,
the cost is much less than what you'd pay without insurance

Learn more about your costs

See your premium

1. Monthly cost may vary

First three non-routine doctor visits
for $35 or less per visit

Access to great doctors and
facilities throughout Massachusetts

Deductible of $6,350 for
individuals and $12,700 for families
for all other services

Help to quit smoking

Massage and
acupuncture discounts

And more to help you
live your life healthier

The Details

Benefits

Preventive care, routine physicals, OB/GYN, well child, routine hearing and vision exams, family planning

You Pay: $0 (no copay or deductible)

Office visits (sick care, non-preventive)

For first three visits each year, you pay 50% or $35 per visit (whichever is less).

For additional visits, you pay up to your deductible amount and then there's no charge.

Emergency room, inpatient hospital care, outpatient surgery

After you pay your deductible, there is no charge.

Prescription drug coverage

With this plan, you pay nothing for Tier 1 (mainly generics) birth control. For all other covered prescriptions, you pay up to the amount of your deductible and then there is no charge.

Plan Specifics

Deductible

You Pay: $6,350 (individual)
or $12,700 (family)

Doctors & Hospitals

Your Primary Care Provider

When you enroll in this health plan, you must choose a primary care provider in Massachusetts.

Referrals Are Required

If you need care from a specialist, your primary care provider will refer you to one. You must have a referral in order for your specialist care to be covered.

Emergency Care

In an emergency, go to the nearest medical facility or call 911. Once you’ve met your deductible for the year, emergency care is at no charge.

After-Hours Care

When you need care and your doctor’s office is closed, you have options:

  • Call the Blue Care LineSM toll-free at< br/>1-888-247-BLUE (2583) to speak with a nurse 24/7.
  • Go to an urgent care center if you have an illness or injury that needs immediate attention, but isn't life threatening.
  • ER Alternatives Fact Sheet

What You Pay

In addition to your monthly premium, your plan includes the following types of costs.

Co-insurance
and copayments

With this plan, you are covered for routine preventive care and services at no cost. You also get three doctor visits each year for either 50 percent co-insurance (you pay half the cost of the visit) or a $35 copayment. You do not pay toward your deductible until after these three visits.

Out-of-Pocket
Maximum

Your out-of-pocket maximum is the most you pay per plan year for covered health expenses before the plan pays 100 percent of covered expenses for the rest of that year.

This plan's out-of-pocket maximum is $6,350 per individual or $12,700 per family.


Deductible

Your deductible is the amount you pay before your insurance begins picking up any of the costs for most services. After you pay your deductible, you’ll pay nothing for covered services for the rest of the year. (Note: Your monthly premium payments don't count toward your deductible).

This plan's deductible is $6,350 per individual or $12,700 per family.

How It Works

Wellness

Resources

About Us

We are a community-focused, tax-paying, not-for-profit health plan rated among the nation's best for member satisfaction and quality that is committed to:

  • Making quality health care affordable
  • Improving the health of the communities where we live and work through our environmental sustainability program
  • Our promise to always put our members first
Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© 2014 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
Landmark Center, 401 Park Drive, Boston, MA 02215-3326 | 800-262-BLUE (2583)

Live Your Life

The Plan

You Get

Coverage

  • With HMO Blue Essential you are covered just in case you get sick or injured
  • And for around $2151 per month, the cost is much less than what you'd pay without insurance

1. Monthly cost may vary

Benefits

  • No cost for routine preventive-care doctor visits and services
  • First three non-routine doctor visits for $35 or less per visit2
  • Access to great doctors and facilities throughout Massachusetts
  • Deductible of $6,350 for individuals and $12,700 for families for all other services

2. Medical-care outpatient visits with primary care provider, OB/GYN physician, physician assistant, nurse practitioner, and nurse-midwife services. You pay 50 percent co-insurance or a $35 copayment per visit, whichever is less.

Extras

  • Gym membership savings
  • Help to quit smoking
  • Massage and acupuncture discounts
  • And more to help you live your life healthier

The Details

Benefits

  • Preventive care, routine physicals, OB/GYN, well child, routine hearing and vision exams, family planning:
    $0 (no copay or deductible).
  • Office visits (sick care, non-preventive):
    For first three visits each year, you pay 50 percent or $35 per visit (whichever is less). For additional visits, you pay up to your deductible amount and then there's no charge.
  • Emergency room, inpatient hospital care, and outpatient surgery:
    After you pay your deductible, there is no charge.
  • Prescription Drug Coverage:
    With this plan, you pay nothing for Tier 1 birth control (mainly generics). For all other covered prescriptions, you pay up to the amount of your deductible and then there is no charge.

Plan Specifics

  • Deductible:
    $6,350 (individual) or $12,700 (family)

Doctors & Hospitals

Your Primary Care Provider

  • When you enroll in this health plan, you must choose a primary care provider in Massachusetts.

Referrals Are Required

  • If you need care from a specialist, your primary care provider will refer you to one. You must have a referral in order for your specialist care to be covered.

Emergency Care

  • In an emergency, go to the nearest medical facility or call 911. Once you've met your deductible for the year, emergency care is no charge.

After-Hours Care

When you need care and your doctor's office is closed, you have options:

  • Call the Blue Care LineSM toll-free at 1-888-247-BLUE (2583) to speak with a nurse 24/7.
  • Go to an urgent care center if you have an illness or injury that needs immediate attention but isn't life threatening.

What You Pay

In addition to your monthly premium, your plan includes the following types of costs.

Co-insurance and Copayments

With this plan, you are covered for routine preventive care and services at no cost. You also get three doctor visits each year for either 50 percent co-insurance (you pay half the cost of the visit) or a $35 copayment. You do not pay toward your deductible until after these three visits.

Out-of-Pocket Maximum

  • Your out-of-pocket maximum is the most you pay per plan year for covered health expenses before the plan pays 100 percent of covered expenses for the rest of that year.
  • This plan's out-of-pocket maximum is $6,350 per individual or $12,700 per family.

Deductible

  • Your deductible is the amount you pay before your insurance begins picking up any of the costs for most services. After you pay your deductible, you'll pay nothing for covered services for the rest of the year. (Note: Your monthly premium payments don't count toward your deductible).
  • This plan's deductible is $6,350 per individual or $12,700 per family.

Wellness

Fitness Benefit

Money for monthly membership fees for three consecutive months of one family or individual health club membership, or for up to ten fitness classes taken by any combination of subscriber, spouse, and dependent children enrolled under the same plan, at a qualified health club during a calendar year.

Get the Details

Weight Loss Benefit

Money for your costs for up to three months of participation in qualified weight-loss program(s) each calendar year. A qualified weight-loss program is a hospital-based weight-loss program or a non hospital-based weight-loss program approved by Blue Cross. You can claim this three-month weight-loss program benefit once each calendar year for any combination of members (the subscriber, spouse, and dependent children) enrolled under the same plan.

Get the Details

Health News, Articles, and Info

Visit AHealthyMe.com for everything to live a healthier life.

Feel Good

Pregnancy & Baby

Living Healthy Babies®' offers online information and support for moms and moms-to-be.

What to Know

Quit Smoking

If you're ready to quit smoking, our Living Healthy Smoke-freeSM program can help with telephone counseling, prescription coverage for nicotine replacement products, and online support.

Quit Now

Resources

Nurse Hotline

Call the toll-free Blue Care LineSM for answers to your health care questions 24 hours a day at 1-888-247-BLUE (2583).

Get Answers Fast

Find a Doctor

Search for a doctor, hospital, or other health care provider near you.

Find a Doctor

Blue365®h3

Because health is a big dealSM. Get exclusive deals on health and wellness.

Deal of the Week

Member Central

Once you're a member, log in and:

  • Check your claims
  • See how much you have paid toward your deductible and out-of-pocket maximum
  • Search for doctors and hospitals
  • And more

Visit Member Central

Mobile and Social

You are on the go. We are too. Whether you are looking to get connected with us through mobile apps, SMS and text programs, mobile websites, or social media, you can access all of our mobile services in one place.

Mobile and Social

About Us

We are a community-focused, tax-paying, not-for-profit health plan rated among the nation's best for member satisfaction and quality that is committed to:

  • Making quality health care affordable
  • Improving the health of the communities where we live and work through our environmental sustainability program
  • Our promise to always put our members first