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How we cover your care is changing

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We work with certain doctors, hospitals and specialists to give you the best member discounts for care. We call this your provider network. In 2019, we’re switching from a Preferred Provider Organization (PPO) to an Exclusive Provider Organization (EPO). This change means your health plan will only cover non-emergency care if you go to in-network providers. If you go to out-of-network providers, you’ll have to pay the full cost of your care unless it's a life-threatening emergency.

When you get care in Tennessee, you’ll be covered when you see any of the thousands of providers in Blue Network SSM. And when you’re out of state, you can see any provider in the BlueCard® PPO network.

We know this is a lot of information, so we’ve created the chart below to help.

Is Your Care Covered?

NON-EMERGENCY EMERGENCY
Blue Network S
Inside Tennessee
Yes
Yes
Out-of-Network Provider
Inside Tennessee
No
Yes, but you’ll still pay for more of your care
BlueCard PPO Provider
Outside Tennessee
Yes
Yes
Out-of-Network Provider
Outside Tennessee
No
Yes, but you’ll still pay for more of your care

It’s important to remember that even in an emergency, you’ll pay for more of your care if you go to a provider that isn’t in your network.

Your 2019 plan options

Changing to an EPO means the plans we offered in 2018 won’t be available in 2019. If you have one of our 2018 plans, you should have received a letter recommending a new plan. If you like it, we’ll automatically enroll you in it. But if you don’t think it’s right for you, we have others you can choose from.

If you’re interested in signing up for one of our 2019 plans, we recommend you take these simple steps:

  • Look for the plan that’s right for you. If you sign up for a plan on the Health Insurance Marketplace, you may qualify for financial help to lower the cost of your premiums.
  • If you got help paying for your plan in 2018, you should see that amount listed on the letter we sent you. The monthly payment amount shown on this letter is an estimate based on 2018 subsidies. We won’t have 2019 subsidy amounts for our members from the government in time for these letters, so you should visit healthcare.gov to update your application and see how much financial help you qualify for in 2019. You can also click here to estimate how much help you might get in 2019.*
  • If you go to providers who aren’t in Network S, you’ll have to pay the full cost of your care. But the good news is that it’s easy to make sure your providers are in Network S. Just go to our Find a Doctor tool and search for your providers by name. Or just give us a call at 1-800-565-9140 Monday through Friday, 8. a.m. to 6 p.m. And don’t forget that open enrollment is Nov. 1 through Dec. 15. If you need help selecting a plan, you can call us at 1-888-995-7786. Or talk to a certified application counselor, an enrollment assistor, or a licensed broker or agent.

*This is just an estimate—you’ll need visit Healthcare.gov to see an exact amount, or wait until you get your first bill in January before you know your exact cost.