Search
FAQs for Routine Adult Physical Exams
ADD FAQs
What are my benefits for a routine physical/routine health checkup?
Your well-being is our top priority. Most of our plans cover routine physical exams and immunizations at no cost* to you when administered by your selected primary care physician contracted within your network. Click to view your Benefit Description details.
*Under certain conditions, costs may apply.
*Under certain conditions, costs may apply.
Does my plan cover the shingles (flu, travel) vaccine?
Most plans cover recommended preventive and travel immunizations without cost share.* This includes but is not limited to: flu shots, travel immunizations, shingles (Shingrix) and meningococcal vaccine.
Members can get their immunizations from an in-network provider or at an outpatient clinic. Members with pharmacy benefits with us may also be able to receive immunizations at retail pharmacy locations affiliated with Express Scripts®′ that offer vaccines.
*Under certain conditions, costs may apply.
Members can get their immunizations from an in-network provider or at an outpatient clinic. Members with pharmacy benefits with us may also be able to receive immunizations at retail pharmacy locations affiliated with Express Scripts®′ that offer vaccines.
*Under certain conditions, costs may apply.
What are my benefits for a mammogram, colonoscopy?
Most preventive screenings are included in your plan at no additional cost.* If a service/procedure is ordered due to signs and/or symptoms, to check on an existing issue or to diagnose a health concern, cost share may apply.
Check your Benefit Description for more details.
*Under certain conditions, costs may apply.
Check your Benefit Description for more details.
*Under certain conditions, costs may apply.
Does my plan have a fitness and/or weight-loss benefit? What types of things are covered by that benefit?
We're dedicated to your well-being. Our fitness benefit and/or weight-loss benefit can save you and your family on qualified expenses annually.
To submit for reimbursement, use our online submission form.
To see what's covered by your plan, visit the Benefit Description tab.
To submit for reimbursement, use our online submission form.
To see what's covered by your plan, visit the Benefit Description tab.
Do I need a referral from my PCP to see a specialist? Will I have a co-pay?
HMO plans, like HMO Blue® and HMO Blue New England,SM require a PCP referral before seeing a specialist. Because your PCP knows your history and health care needs, they are best qualified to help you decide whether a specialist is needed.
Blue Choice® and Blue Choice New EnglandSM members have the option to self-refer for covered services but may incur a higher out-of-pocket cost.
Members on PPO plans do not require a referral to see a specialist.
To determine your cost share for these services, click the Costs tab.
Blue Choice® and Blue Choice New EnglandSM members have the option to self-refer for covered services but may incur a higher out-of-pocket cost.
Members on PPO plans do not require a referral to see a specialist.
To determine your cost share for these services, click the Costs tab.
Can you tell me what tier this provider I have been referred to is on?
With the Find a Doctor & Estimate Costs tool, you can search for your provider and see their tier. View the Find a Doctor & Estimate Costs tool. When logged into the Find a Doctor tool, results will populate according to your plan.
Do I need a referral/authorization for an MRI (X-Ray, mammogram)?
The need for referrals can vary by plan type and type of service. Tests that may not need a referral or authorization, may still require an order from a physician. Details for your plan can be found on the Benefit Description tab.
Benefit Category
Routine Adult Physical Exams
Keywords
annual physical, blood work, lab work, bone density, Osteoporosis, Osteoporosis screening, cologuard, cologard, colonoscopy, covid test, covid test reimbursement, covid tests, covid vaccine, fitness & weight loss benefit, fitness, fitness reimbursement, fitness benefit, fitness program, fitness and weightloss reimbursement, fitness and weightloss benefit, fitness & weightloss reimbursement, gym reimbursement, gym membership, gym, health reimbursement, fitness reward, fitness form, fitness rebate, flu shot, immunization, lab, "labs, laboratory, Lab work, weight, weight loss
Blood work", mamogram, mammogram, Breast exam, physical, annual exam, checkup, routine exam, physical therapy, PT, silver sneakers, Fitness reimbursement, Gym reimbursement, telehealth, Virtual Care, Video Visit, Firefly, Carbon Health, Brightline, vaccinations, vaccination, vacine, vacination, vaccine, vaccines, shingles vaccine, shingles shot, shingles, rsv vaccine, travel vaccination, health club, gym, primary care, PCP, Primary doctor, Physician of Choice, testosterone
Blood work", mamogram, mammogram, Breast exam, physical, annual exam, checkup, routine exam, physical therapy, PT, silver sneakers, Fitness reimbursement, Gym reimbursement, telehealth, Virtual Care, Video Visit, Firefly, Carbon Health, Brightline, vaccinations, vaccination, vacine, vacination, vaccine, vaccines, shingles vaccine, shingles shot, shingles, rsv vaccine, travel vaccination, health club, gym, primary care, PCP, Primary doctor, Physician of Choice, testosterone
FAQs for Medical Care Outpatient Visits
ADD FAQs
What are my benefits for chiropractic care?
Chiropractic coverage depends on your plan. To view your chiropractor services benefits and limitations, click here.
What are my benefits for physical therapy?
Your coverage details for physical therapy are found under your Short Term Rehabilitation benefit.
Can you provide me with in-network providers for physical therapy (chiropractic care, acupuncture)?
To find in-network providers, use our Find a Doctor & Estimate Costs tool. For certain holistic practitioners, you can also use our Holistic Care tool.
Benefit Category
Medical Care Outpatient Visits
Keywords
Acupuncture, accupuncture, accupunter, acupunter, qualified conditions for acupuncture, acupunture, acupucture, acupuncure, acupuncture benefit, acupuncture benefits, acupuncture visits, acupunctur, acupuncture provider, acupuncture coverage, is acupuncture covered, acupuncture reimbursement, acupunture reimbursement, adhd, allergy, allergy shots, allergies, allergy testing, cataract surgery, cataract, eye surgery, endoscopy, dermatologist, skin doctor, dermatology, skin, skin doctor, rash, mole, eye doctor, immunization, optometry, optometrist, oral and maxillofacial surgery, oral surgery, wisdom teeth, oral surgeon, podiatrist, sleep apnea, "Sleep study***, immunization, Virtual Care, Video Visit, attention deficit, urgent, urgent care, urgent care centre, urgentcare , walk in clinic, clinic, botox, botox injection, prenatal, ophthalmologist, opthalmology, eye specialist, obgyn, gyne, gynecology, ketamine, ketamine injection, hearing, hearing aid, hearing aid coverage, hearing aids,
Sleep, Sleep Apnea sleep disorder CPAP, BPAP, DPAP*", specialist, telehealth, Firefly, Carbon Health, Brightline, testosterone, urgent care, urgent, urgentcare, urgent care center, walk in clinic, clinic, vision benefits, vision, vision care, vision coverage, vision plan, weight management, eye care, eye coverage, eye exam, eye exams, eye glasses, glasses, international coverage, international medical insurance, international claims, international health insurance coverage, international travel, international travel coverage, international travel insurance, coverage out of the country, coverage when out of country, worldwide benefits, traveling outside the usa, coverage in foreign country, travel outside united states, travel insurance, travel coverage, emergency care abroad, am i covered when traveling, covered out of country, covered overseas, Foreign Travel, primary care, PCP, Primary doctor, Physician of Choice
Sleep, Sleep Apnea sleep disorder CPAP, BPAP, DPAP*", specialist, telehealth, Firefly, Carbon Health, Brightline, testosterone, urgent care, urgent, urgentcare, urgent care center, walk in clinic, clinic, vision benefits, vision, vision care, vision coverage, vision plan, weight management, eye care, eye coverage, eye exam, eye exams, eye glasses, glasses, international coverage, international medical insurance, international claims, international health insurance coverage, international travel, international travel coverage, international travel insurance, coverage out of the country, coverage when out of country, worldwide benefits, traveling outside the usa, coverage in foreign country, travel outside united states, travel insurance, travel coverage, emergency care abroad, am i covered when traveling, covered out of country, covered overseas, Foreign Travel, primary care, PCP, Primary doctor, Physician of Choice
FAQs for Outpatient surgery
ADD FAQs
What are my benefits for outpatient surgery?
Your benefits for outpatient surgery can be found by clicking on the Benefit Description tab.
Do I need a referral or authorization for an upcoming surgical procedure?
Some outpatient surgical procedures may require prior authorization. Please check with your provider or call Member Service at the number on your ID card.
What is my cost share for my upcoming outpatient surgical procedure?
Your cost share details for outpatient surgical procedures can be found by clicking on the Costs tab .
You can also use our Cost Estimator Tool to help plan for any expenses.
You can also use our Cost Estimator Tool to help plan for any expenses.
Benefit Category
Outpatient surgery
FAQs for Durable Medical Equipment
ADD FAQs
Does my plan cover a glucometer?
Your plan comes with more features and health benefits than you might realize. Like a OneTouch®″ glucose monitor at no additional cost. Click to learn more about ordering a glucose monitor.
Do I need a prescription to be covered for durable medical equipment (DME)? Do I need an authorization for my equipment to be covered?
Your durable medical equipment benefit is available with a letter of medical necessity. To review your individualized plan benefits, click the
Benefit Description tab.
What durable medical equipment (DME) providers are in my network?
Use our Find a Doctor & Estimate Costs tool to find durable medical equipment providers in your network. Log in, or enter your network and zip code and then select "All Specialties" in the search bar. Under "D" you will see options for DME providers.
Benefit Category
Durable Medical Equipment
Keywords
breast pump, cpap, sleep apnea, occupational therapy, novolog, orthopedic, physical therapy, PT, podiatrist, "Sleep study***
Sleep, Sleep Apnea, surgery, orthotics, emergency room, ER visit, emergency department,
Sleep disorder,
CPAP, BPAP, DPAP*", hearing, hearing aid, hearing aid coverage, hearing aids, insulin, "Diabetes,
Continuous Glucose Monitor
Insulin Pump
Dexcom", lantus, omnipod,
Sleep, Sleep Apnea, surgery, orthotics, emergency room, ER visit, emergency department,
Sleep disorder,
CPAP, BPAP, DPAP*", hearing, hearing aid, hearing aid coverage, hearing aids, insulin, "Diabetes,
Continuous Glucose Monitor
Insulin Pump
Dexcom", lantus, omnipod,
FAQs for Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
ADD FAQs
What are my benefits for behavioral health services?
Behavioral health services are assessment and therapeutic services that are used in the diagnosing and treatment of mental health and substance use disorders. This ranges from outpatient office visits with a specialist to inpatient psychiatric treatment.
To review your individualized plan benefits, click the Benefit Description tab.
To review your individualized plan benefits, click the Benefit Description tab.
Do I need a referral/authorization for behavioral health services?
The need for referrals/authorizations can vary by the type of service. To see what's covered by your plan, Click here.
Am I covered to see my psychologist/behavioral health provider via telehealth?
We’re expanding the types of care available via telehealth to better meet the needs of our members. Any medically necessary service covered under a member’s health plan can now be performed via telehealth (by video or phone) when appropriate, and offered by your doctor.
For Medicare HMO Blue and Medicare PPO Blue members telehealth is covered for outpatient mental health visits when appropriate and offered by your network provider.
For Medicare HMO Blue and Medicare PPO Blue members telehealth is covered for outpatient mental health visits when appropriate and offered by your network provider.
Is my provider in my plan network?
To verify whether your provider is in-network use our Find a Doctor & Estimate Costs tool. You can then search by provider name, medical group, facility name, or specialty type. To find providers in your network, sign in to the tool or or enter your network and the geographical area you would like to search.
Benefit Category
Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
Keywords
adhd, attention deficit, behavioral health, mental health, counseling, counselling, autism, mental health, mental health benefit, mental health coverage, psychotherapy, psychological testing, psychiatric, psycologist, psychiatry, licensed mental health counselor, psychiatric evaluation, psychological, psychotherapist, mental & behavioral health, mental health care for depression, depression, psychatrist, psycotherapy, psychology, psychologist, therapist, therapy, behavioral health, telehealth, Virtual Care, Video Visit, Firefly, Carbon Health, Brightline