MEMBER GUIDE

Learn 5 steps to use your health plan. Read this guide to understand how to get the most from your healthcare benefits.

Welcome. Let’s Get Started!

STEP 1

Once you get your ID card, be sure to keep it in a safe place.

You’ll need your ID card when you:

  • Visit a doctor or other healthcare professional
  • Pick up a drug that your doctor has ordered for you
  • Visit an urgent care clinic, hospital, or emergency room
  • Call Member Services

You can also view your member ID card on the go using the MyBlue® app. Download the MyBlue app on Google Play and the App Store®. You’ll need your member ID to sign up.

If you lose your card, you’re still covered. You can order a new card through your member account, azblue.com/MyBlue.

*Your wireless plan’s phone and data rates may apply. App Store is a registered trademark of Apple Inc. Google Play is a trademark of Google Inc.

Sample Member ID Card

Click on these dots to learn more about your ID card.

STEP 2

Sign Up for MyBlue®

Your MyBlue® member account is one of the most important resources you have as a member. Once you have your member ID number, you can sign up for your personalized MyBlue account. There, you will be able to:

  • Check on the status of your claims
  • See where you are in meeting your deductible and yearly maximum
  • Find doctors, hospitals, or other healthcare providers in your plan’s network
  • Use health and wellness tools and resources
  • Get estimates for healthcare costs by using the cost estimator tool for common conditions

You get all this and more – just by registering for your MyBlue member portal account.

STEP 3

Know How to Use Your Health Plan

  1. Always go to your designated Primary Care Provider (PCP).

    Your Primary Care Provider (PCP), is your point person who provides primary care to you. Your PCP must coordinate your care with specialists or other care providers, when needed. To get started, we selected one for you, but you can change your PCP up to six times a year. If your designated PCP is not available, you are able to see another doctor within the same practice to coordinate your care. If you visit a doctor outside of your PCP’s practice, you’ll be responsible for the full cost of care.

  2. If you need to see a specialist, ask your PCP for a referral.

    When your PCP refers you to a specialist or other providers, they must be in your plan’s network. Your plan won’t cover most specialist visits without a referral from your PCP. You can check to see if they are in your plan’s network by using the “Find A Doctor” tool on your personalized MyBlue account. Referrals are not required for visits to chiropractors, OB/GYNs, and certain other specialists.

    Check to see if your referral request was approved by logging into your MyBlue account. Once your referral is approved, you can schedule an appointment with the specialist.

  3. Staying in network can save you money.

    Out-of-network providers aren’t covered by your plan except for emergency care. Avoid surprise costs by making sure that your doctor, hospital, or urgent care is in your plan’s network before your visit. They can also refer you to another PCP. To find doctors in your plan’s network, sign in to MyBlue, and then click “Find a Doctor“. To learn more about PCPs, getting a referral to see a specialist, and how your health plan works, visit azblue.com/learnmore.

STEP 4

Find Doctors and Other Providers

Not able to watch the video? You can also read about finding in-network providers.

You have access to a “Find A Doctor” tool that lists doctors, other healthcare professionals, hospitals, and facilities.

Log in to your personalized MyBlue account and click on “Find a Doctor.” You will be able to search for a provider who is in your plan’s network by provider name, type of provider, or within a certain distance of your location.

It’s always good to check if providers are in your plan’s network before you see them. This tool makes it easy to find the care you need. You can also read reviews, get estimates, and compare costs of services.

STEP 5

Learn How Health Plans Work

Health plans protect you by lowering the total cost of care and reducing how much you have to pay.

When getting care, there are some terms you should know because they can change what you pay out of your own pocket. Let’s look at an example.

View Scenario

Your friend wakes up with stomach pain. She calls her in-network doctor to be seen right away. She pays a $15 copay for seeing her doctor.

After being seen, her doctor tells her she’ll need surgery totaling $55,000.

Her health plan has a

$4,000 deductible for the calendar year, which she must pay first. She hasn’t paid any of it yet, so she’ll pay $4,000.

After that’s paid, she has a 20% coinsurance for the surgery.

BCBSAZ’s allowed amount is $35,000. Subtract her $4,000 deductible from the $35,000 allowed amount to get $31,000. Your friend is using an in-network provider so her coinsurance is 20% of $31,000.

Once your friend reaches her total out-of-pocket maximum,

which is $6,650 for her plan, BCBSAZ will pay 100% of the cost of her care for covered services for the rest of the year.

In Summary:

ALLOWED AMOUNT:

$35,000

DEDUCTIBLE:

$4,000

DIFFERENCE:

$31,000

COINSURANCE:

$6,200 (20% coinsurance x 31,000)

TOTAL:

$10,200

YOUR FRIEND PAYS:

$6,650

Your friend is protected by her out-of-pocket maximum, so she pays $6,650 instead of $10,200 for covered services. That’s how health plans protect both your health and wallet!

LOOKING FOR MORE INFORMATION?

Explore Now

ADDITIONAL LINKS

© Copyright 2019 Blue Cross Blue Shield of Arizona. An independent licensee of the Blue Cross and Blue Shield Association.