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