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    • Welcome to Blue Cross Blue Shield of Massachusetts!
    • Employer Portal
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        • Plan Types
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          • PPO
          • BlueFit
          • POS
          • Medicare Options
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          • Consumer Directed Health Plans
          • Healthy Actions
          • Tiered Network / Blue Options
          • Pharmacy Benefit Features
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        • Plans and Networks
        • Dental Total Health
        • Accumulated Maximum Rollover Benefit
        • Dental Blue Voluntary Community Rated
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Blue Options

Its Benefits

<< Return to Tiered Network/Blue Options

  • Does the hospital tiering apply to all hospitals in Massachusetts?
  • What's the difference between an ambulatory surgical facility and surgical day care unit?
  • What is the member's cost-share responsibility when the member is admitted to a Basic Benefits Tier facility and then transferred to a Standard Benefits Tier facility?
  • If a member is admitted to an Enhanced Benefits Tier hospital but is then transferred to a Basic Benefits Tier hospital, what is the member's cost-share responsibility?
  • What happens when a member is re-admitted to a facility?
  • What happens when a newborn baby with a medical condition is transferred from one facility to another facility?
  • Why do the new Blue Options deductible plans have an out-of-pocket (OOP) maximum and the existing Options plans (copays only) do not?

Does the hospital tiering apply to all hospitals in Massachusetts? 

The hospital tiering only applies to acute care/general hospitals in Massachusetts. The Blue Options plans also tier primary care providers.

If a member is admitted to a hospital through the emergency room (ER) the ER copayment is waived and he/she will be responsible for the Enhanced Benefit Tier cost-share level for the inpatient admission up to their out-of-pocket maximum.

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What's the difference between an ambulatory surgical facility and surgical day care unit? 

A surgical day care unit is part of a hospital and bills as a hospital. An ambulatory surgical facility can be a freestanding surgical facility, not associated with a hospital.

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What is the member's cost-share responsibility when the member is admitted to a Basic Benefits Tier facility and then transferred to a Standard Benefits Tier facility? 

`The member is responsible for the Basic Benefits Tier deductible and inpatient copayment, up to their out-of-pocket maximum. The member is not responsible for any additional Standard Benefits Tier cost-share (deductible and/or copayment) because this was a transfer and not a separate admission.

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If a member is admitted to an Enhanced Benefits Tier hospital but is then transferred to a Basic Benefits Tier hospital, what is the member's cost-share responsibility? 

The member is responsible for the Enhanced Benefits Tier inpatient copayment (there is no deductible on Enhanced Benefits Tier admissions). The member is not responsible for the Basic Benefits Tier cost-share (deductible and/or copayment) because this was a transfer and not a separate admission.

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What happens when a member is re-admitted to a facility?

The member is not responsible for a new inpatient admission cost-share (deductible and/or copayment) if he/she is re-admitted to the same facility within seven days from being discharged from the hospital for the same or related DRG.

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What happens when a newborn baby with a medical condition is transferred from one facility to another facility?

For well newborns, the inpatient admission cost-share is satisfied through the mother's admission. A newborn baby with a medical condition who is transferred from the birth location to another facility is not responsible for an inpatient admission cost-share (deductible and/or copayment).

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Why do the new Blue Options deductible plans have an out-of-pocket (OOP) maximum and the existing Options plans (copays only) do not?

According to minimum credible coverage (MCC) standards, if a health benefit plan includes deductibles or co-insurance for in-network core services, the plan must set out-of-pocket maximums for in-network covered services that do not exceed $5,000 for an individual and $10,000 for a family. Our new Blue Options deductible plans, meet this definition, and therefore, the $5,000/$10,000 out-of-pocket maximum applies. Our existing Options plans do not require the $5,000/$10,000 out-of-pocket maximum in order to meet MCC standards.

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ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-200-4255 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar  1-800-200-4255 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-200-4255  (TTY : 711 ).

注意:如果您讲中文,我们可向您免费提供语言协助服务。请拨打您 ID  卡上的号码联系会员服务部 通话 1-800-200-4255(TTY  号码:711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-200-4255 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-200-4255 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов  1-800-200-4255 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ  វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្  រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ  វាសមា  ជិកតាមល េខន  ៅល.  ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-200-4255 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata  1-800-200-4255 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-200-4255 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-200-4255 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-200-4255 (TTY: 711 ).

ध्यान दें: य दि  आप ह िन् दी बोलते ह ैं, तो भा षा  सहाय  ता  सेवा एँ, आप के लि ए नि :शुल्क  उपलब्ध ह ैं। सदस्य  सेवा ओं को आपके आई.डी. कार  ्ड पर दि ए गए नंबर पर कॉल करें  कॉल 1-800-200-4255 ( टी .टी .वा ई.: 711).

ધ્યાન આપો:  જો તમે ગુજરા તી બોલતા  હો, તો તમને ભા ષા કીય  સહાય  તા  સેવા ઓ વિ ના  મૂલ્યે  ઉપલબ્ધ છે. તમા રા  આઈડી કાર  ્ડ પર આપેલા  નંબર પર Member Service  ને કૉલ કરો કૉલ કરો 1-800-200-4255 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-200-4255 (TTY: 711 ).

お知らせ:日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-200-4255(TTY: 711 )。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-200-4255 (TTY: 711 ).

ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-200-4255 (TTY: 711).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-200-4255 (TTY: 711).

BAA !KOHWIINDZIN DOO&G&: Din4 k’ehj7 y1n7[t’i’go saad bee y1t’i’ 47 t’11j77k’e bee n7k1’a’doowo[go 47 n1’ahoot’i’. D77 bee an7tah7g7 ninaaltsoos bine’d44’ n0omba bik1’7g7ij8’ b44sh bee hod77lnih call 1-800-200-4255 (TTY: 711).