Page 6 - 2021-blue-solutions-small-group-renewal-guide

Driving members to the most cost-effective settings
The Site of Service (SoS) benefits in every Blue Solutions plan1 give members the choice to save money when accessing certain services based on where care is received. By driving members to the most cost-effective settings, we are working to help reverse rising health care cost trends year over year.
Members can lower their out-of-pocket costs based on the location where they receive care for the following services:
Outpatient labs
• In most PPO plans, cost-sharing for covered services is $0 at freestanding in-network labs.
• In HMO and Direct POS plans, members pay $0 for in-network lab services when using their
PCP’s designated lab.
Outpatient surgery2
• Lower cost-sharing for services at in-network ambulatory surgical centers (ASCs) • Higher cost-sharing at hospital-based sites
Preventive colonoscopy3
• $0 preventive colonoscopy when performed by non-hospital-based Preventive Plus providers and GI professionals
Physical/occupational (PT/OT) therapy
• Lower cost-sharing at office-based providers and freestanding sites • Higher cost-sharing at hospital-based sites
Routine/complex radiology
• Lower cost-sharing at office-based providers and freestanding sites • Higher cost-sharing at hospital-based sites
Biotech/specialty injectables and infusion
• Lower cost-sharing when a drug is administered in the home or doctor’s office • Higher cost-sharing in an outpatient setting
1. Site of Service benefits vary by plan design. Refer to the health plan charts beginning on page 34 for more details.
2. Common outpatient surgical procedures performed at ambulatory surgical centers (ASCs) include tonsil removal, hernia repairs, and cataract surgeries.
3. Members pay $750 out of pocket by choosing non-Preventive Plus providers and professionals. Age and frequency guidelines apply to preventive care, such as
colonoscopies. The Preventive Plus benefit does not apply to members who reside or travel outside our service area and access care through the BlueCard® Program or the Away From Home Care® Guest Membership Program. For these members, a preventive colonoscopy to screen for colorectal cancer will be covered at no cost when they use an in-network provider. If they choose to visit an out-of-network provider, cost-sharing for their plan’s out-of-network benefit applies, and their out-of-pocket costs may be significantly higher. Diagnostic colonoscopies are subject to the cost-sharing provision of the member’s outpatient surgery benefit.
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