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What Is a Health Plan?
A health plan is a generic term referring to a specific benefit package offered by an insurer, HMO, PPO or self-funded employer plan.
What Is a Provider Network?
Health plans use select groups of doctors, hospitals and other health care professionals who work together to provide a full range of covered health care services. These are called provider networks. Some provider networks have fewer doctors and hospitals than others. Plans with smaller networks may have lower monthly premiums than plans with larger networks.
Which Health Plan or Network Do You Have?
Your health plan or network is shown on the front of your Blue Cross and Blue Shield of Texas (BCBSTX) member ID card. If you have questions about which network you have, call the Customer Service number on the back of your card.
Keep Costs Down. Stay in Network with Provider Finder®
If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost. For HMOs, if you are referred to a specialist, make sure he or she is in your network.
Search Provider Finder before you see a doctor or go to the hospital.
Common Health Plans and Networks
The three most common types of health plans are:
An HMO is a type of health plan that often has lower monthly premiums and out-of-pocket costs, like copayments and deductibles. HMOs only cover health care services given by doctors and hospitals in the plan's provider network. Not all HMO plans are the same. Some HMOs may have a smaller network and lower monthly premiums than other HMOs.
Key Things to Remember about HMOs:
About Your Primary Care Physician (PCP)
When you first sign up for an HMO, you choose, or are assigned, a primary care physician (PCP). These doctors and medical professionals focus on general practice, internal medicine and family practice. An obstetrics-gynecology doctor can serve as a woman's PCP. A pediatrics doctor can serve as a child's PCP.
A PPO is a type of health plan that gives you the most flexibility, in most cases, but often has higher monthly premiums and out-of-pocket costs, like deductibles and coinsurance, than other plans. Like HMOs, each PPO uses a certain network of doctors, specialists and hospitals. Some lower-cost PPOs have fewer doctors and hospitals than other more costly PPOs and some HMOs.
Key Things to Remember about PPOs:
Consumer Directed Health Plans (CDHPs) often involve pairing a high deductible PPO plan with a tax-advantaged account, such as a Health Savings Account (HSA). An HSA is a savings account that you can use to cover a wide range of qualified medical costs. HSAs have special tax advantages and are regulated by the Treasury Department.1
Key Things to Remember about CDHPs
1 Health Savings Accounts (HSA) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.