Health Insurance Shopper s Guide Information to help you choose a health plan for you and your family.

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Health Insurance Shopper’s Guide

InformatIon to help you choose a health plan


HealtH InSurance?


who needs

nobody knows the future. But you

can plan for it and protect yourself and

your family with health insurance.

health insurance can:

• Help you get the healthcare you need

• Protect you from large medical bills

• Give you access to important preventive care

• Bring peace of mind when you need it most



It’s a whole new world of choices. Blue Cross Blue Shield of Arizona is here to help. We’ve been part of your community for over 70 years. And we’re here to help make the process of finding and buying health insurance easier than you thought possible. Here’s how.

Find out if you qualify for lower cost health insurance

You may be able to get help from the U.S. government to pay for your plan. The amount of financial help you can receive depends on your family size and how much you earn. We can help you find out if you qualify.

Find the right health plan at the right price

There are many new health plan choices for 2014. We will take the time to understand your needs and find the plan that works for your life, health and budget.

Help you enroll and get started

Open Enrollment is the set time period when you can buy individual health insurance plans for yourself or your family, unless you later qualify for a special enrollment period due to a divorce, job loss or other reason allowed by the government. Open Enrollment begins October 1, 2013 and ends March 31, 2014.

The good news is that you do not have to go it alone. We can guide you through the enrollment process step by step.





with Blue Cross Blue Shield of Arizona




The Affordable Care

Act requires most

people to have some

form of health plan

coverage beginning

in 2014.

There are two types of financial help – called subsidies – that are available from the U.S. government.

Help paying your monthly health insurance bill (Premium Tax credit) The premium tax credit helps you pay for all or part of your monthly insurance bill or “premium.” If you qualify, this assistance lowers your health insurance costs.

Help paying for medical costs (Cost-Share Subsidy)

If you qualify, this form of financial assistance helps pay your share of the costs of medical services you may receive.


YoU deServe

cUSTomer Service

from people

wHo care

We take pride in serving our members. You get the support and respect of member service teams that live right here in Arizona. But don’t just take our word for it. See how our members rate the service they receive from BCBSAZ.

*Studies of a representative sample of Blue Cross Blue Shield of Arizona customers were conducted during the first three quarters of 2012 by Market Strategies, Inc., an independent research company.

If you don’t have health insurance – or even if you do – you may have questions. Each health plan is different, but here is a quick look at how insurance works for most plans when you get care from doctors, hospitals and other healthcare providers that are part of the health plans’ network:

1. You pay a monthly premium to be a health plan member.

2. For many plans, when you visit your primary care doctor or get a prescription, you often pay a flat fee called a copay. Some plans limit the number of visits with a copay. After you reach the limit, you pay deductible and coinsurance. Copay amounts can vary depending on the type of provider you see or the tier level of the prescribed medication.

3. For many other medical services such as a surgery, x-ray or other medical treatments, you and your health plan share the costs. Your share of the costs includes the deductible and coinsurance.

4. Once you reach your deductible, your health plan pays for most of the cost. You still often have to pay a part of the cost as coinsurance. Once you reach your out-of-pocket maximum, the plan will pay for 100% of most in-network healthcare costs.

Important Insurance Terms

premiUm – This is your monthly bill for insurance. You pay it whether or not you see a doctor or get any medical care. It is the same amount every month during the term of your plan. Premiums can go up at annual renewal.

copaY – A flat dollar amount you pay for some covered services. Copay amounts can vary by plan, healthcare service and type of doctor you see.

dedUcTible – The amount you must pay for covered medical care before your health insurance starts to share the cost. Deductibles vary by health plan. Not everything you pay for – including your premium and copays – counts toward your deductible. You will have to continue to pay for certain things such as copays or coinsurance even after you meet your deductible.

coinSUrance – This is the share of the cost you pay for healthcare received after you meet your deductible. If your plan has a 20%

coinsurance, your insurance may pay 80% of the cost and you might pay 20%. But once you meet your out-of-pocket maximum, your insurance plan pays 100% of qualifying costs.

oUT-of-pockeT maXimUm – The most you pay in a year before your health insurance pays 100% of qualifying costs. These limits put a cap on healthcare costs if you ever have a major illness or injury. This limit generally does not include things like your premium, balance‐bills from providers who aren’t part of the network, or non-covered services.


Overall customer satisfaction*

Satisfaction: Overall


Finding doctors and hospitals*

Satisfaction: w/Assistance


When calling BCBSAZ*

Good experience: Service


Doctor visits

Preventive care

Prescription drugs

Emergency care and

ambulance services

Hospital stays

Maternity and

newborn care

Dental and vision care

for children


wHaT’S covered

The 2014 individual and family health insurance plans cover some basic healthcare services.† No matter what plan you choose, you know it will have coverage for the services listed below. It is important to know that you may need to pay for part of the costs.



When calling BCBSAZ*

Finding the


Health Plan

Choosing the right insurance plan usually comes down to your health and your budget. How much you pay depends on the coverage level of plan you choose. BCBSAZ offers three levels – Bronze, Silver, or Gold. As you can see from chart below, your out-of-pocket costs are higher when you choose a less costly plan. If you want to pay a higher monthly premium, your out-of-pocket costs will be lower.

If you know you need frequent medical care – you may want to consider buying a “Gold” health plan that covers more of the cost of the healthcare services you receive, but has a higher monthly cost or premium. On the other hand, if you are healthy and usually see a doctor only for regular check-ups and routine care, then a lower cost Bronze plan with higher member cost share may be better for you.

choice of doctors, Hospitals and Healthcare providers

When it comes to healthcare, choice of doctors is important. Our statewide network includes more than 90% of the doctors, hospitals and other healthcare providers in Arizona. That means more choices of healthcare for our members. Or you may decide that you want the additional savings you can get from choosing a plan that has a more targeted choice of doctors, hospitals and healthcare providers.

The amount of cost covered depends on type

of plan. All claims for services are subject to review for compliance with plan benefits, limits and exceptions.



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EverydayHealth plan offers fixed copays and fees for many of the healthcare services you and your family use most when you use an in-network provider. This includes doctor visits, urgent care, prescriptions, vision checks, and more. Choose from four plan options to match your budget.


When you need healthcare, it helps to know how much it will cost. With CopayComplete, you simply pay a set copayment for each covered service received from an in-network provider. This simple- to-use plan with $0 in-network deductible covers doctor visits, eye checks, prescriptions, diagnostic tests, and urgent, emergency and maternity care.


With FitRewards, you get a plan that pays you back. Earn $20 each month you exercise regularly at a qualifying gym. Just submit a form showing you went to a gym or fitness facility at least 8 times in a month and we’ll send you a check.* Your in-network primary care visits, eye exams and most prescriptions are covered at low copays too.


Many of your basic care needs are covered at a lower cost by having an Essential plan. This means you pay fixed copays for the first three in-network primary and specialist care office visits each year. You also have a set cost for in-network urgent care, eye checks, and most prescriptions. Choose one of four deductible options that fit your budget.


Take charge of your own healthcare dollars like you do your budget. These high-deductible, low-premium Portfolio plans are designed to work with a Health Savings Account (HSA) from a qualified financial institution. Each of the four plans covers many in-network preventive care services at no charge. Select the deductible level that fits your budget.


You’re never too young for health insurance. A SimpleHealth plan is great for members under age 30.** It provides coverage when you’re sick and helps you stay well, covering most in-network preventive care services at no out-of-pocket cost to you. This plan gives you three visits to your primary care doctor for a low copay. Many in-network services are covered at no cost after you meet your deductible.

Here’s a quick look at the 2014 health plan choices. You’ll find plans to fit every stage of life – making it

easier to find one that works best for you. All of the 2014 individual and family plans cover in-network

preventive care services and kids’ dental check-ups at no out-of-pocket cost to you.

Blue cross Blue Shield of arizona

2014 HealtH Plans

All benefit information is for healthcare services provided by doctors, hospitals and healthcare providers in the BCBSAZ Provider Network. EverydayHealth, CopayComplete, FitRewards, Essential, Portfolio and SimpleHealth are Qualified Health Plans in the Health Insurance Marketplace. All plans generally have limitations and exceptions and exclude coverage for services, medications, and supplies that are experimental, investigational, cosmetic, for treatment of sexual dysfunction, or which BCBSAZ deems not medically necessary.

*FitReward’s Exercise Rewards® program is administered by American Specialty Health Fitness. American Specialty Health Fitness (ASHN) is an independent company that



Open Enrollment is the set time period when you can buy individual health insurance plans for yourself or your family, unless you later qualify for a special enrollment period due to a divorce, job loss or other reason allowed by the government. Open Enrollment begins October 1, 2013 and ends March 31, 2014.

We can help.

Shop and apply online at

You can research your health plans online at We have tools to help you find a health plan that matches your healthcare needs and budget. Just by answering a few easy questions, you can view plan choices and be guided through the application process – even if you are applying for federal financial assistance.

call to Talk to an individual insurance Specialist

You can always call to talk to one of our knowledgeable insurance specialists. They will take the time to understand your needs and help find a plan that’s best for you. They can even guide you through the application and enrollment process.

Get answers.

Get covered.

Call Blue Cross Blue Shield

of Arizona today.


Services available in Spanish

How to buy insurance has changed.