Frequently Asked Questions

Benefits

Understanding your health policy should be simple, so we created a quick start guide to get you started.

There are several ways to know what is covered by your policy.

  • You can refer to the statement of benefits that you received when your policy began.
  • Or you can call the customer service number on the back of your ID card.
  • Another way is to sign in to our self-service web portal, My Blueprint.
  • Here's a short video on how to use My Blueprint and find your benefits

A network is a group of doctors and hospitals that agree to lower their costs in exchange for working directly with a health insurer. Networks help doctors and hospitals because they know if a patient has health insurance, they will get paid. How does it help patients? In-network benefits are services from a doctor or hospital that has contracted with us and is part of a preferred network. These benefits mean lower out-of-pocket costs for you. If you go to a doctor or hospital that has not contracted with us and is out of network, you still benefit from having insurance, but you won’t get the lowest cost for their services. These out-of-network benefits mean higher out-of-pocket costs for you.This means when members visit an in-network doctor, our members will have lower costs than a doctor out-of-network.

Preventive screenings look for diseases or conditions before there are symptoms or signs. Diagnostic tests are done when you and your doctor know you have a health problem and you need to know the cause. To learn more about the two, visit our article "Preventive vs. Diagnostic. What's the difference and why the cost?"

If you don’t have dental or vision coverage, and you would like to get it, don’t fret; we can help. If you have health insurance through your employer, talk to your group administrator about dental and vision plans. You may have to wait until open enrollment to be added to your company’s plans. If you pay for your coverage on your own, Arkansas Blue Cross and Blue Shield also offers individual and family dental and vision products. You can read about them here. One of our friendly agents can also help you. Call 1-800-392-2583.

Payment

If you get your health insurance through your employer, your premium is usually taken care of by a deduction from your paycheck. If you get an invoice for an individual plan, you can see payment options here.

Yes. If you get your insurance through an individual plan, you can pay by check, money order or cashier’s check at an Arkansas Blue Cross location near you.

Cash is not accepted. No transaction fee applies.

Visit any MoneyGram* location to pay by cash or debit card with a PIN. No transaction fee applies. You’ll need a copy of your bill. To find a MoneyGram location near you, call 1-800-666-3947 or visit the MoneyGram website.

*MoneyGram is an independent company that provides health insurance payment services for Arkansas Blue Cross and Blue Shield customers.

Depending on the plan you have, you'll receive a Personal Health Statement (PHS) or an Explanation of Benefits (EOB) each time you visit a doctor so you can keep track of your healthcare spending. It's not a bill but a guide for how to review a bill if your doctor sends you one. To learn more, check out our article "Why we send PHS and EOBs."

Cost

Premiums are the fixed amount you pay each month for your health insurance coverage. Essentially it’s your monthly bill in order to have health insurance, similar to a monthly payment you may make to have car insurance.

Deductibles are the amount you pay for medical costs before your health insurance begins to make payments. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1,000 deductible for allowable charges, not the billed charges.

Copayments (copays) are a fixed amount you pay, usually at the time of healthcare service. Copays are separate from and do not accumulate to the deductible. This amount can vary by the type of service. You may also have a copay when you get a prescription filled.

Coinsurance is the share of the costs you pay, calculated as a percentage (for example, you pay 20 percent, insurance pays 80 percent).

Plans with a higher deductible usually have a lower monthly premium and plans with a lower deductible usually have a higher monthly premium. Therefore, it is important to select a plan based on your needs and budget.

No. Copays are separate from and do not accumulate to the deductible.

Premiums are your monthly bill in order to have health insurance, similar to a monthly payment you may make to have car insurance. Deductibles are the amount you pay for medical costs before your health insurance begins to make payments, similar to the amount you would pay out of pocket before your car insurance contributes to repairs to your car after an accident.

Health insurance premiums go up because costs in the healthcare industry keep increasing. Arkansas Blue Cross and Blue Shield is working to find ways to lower these costs for everyone. To understand how health insurers determine their annual premiums, see the question "How are premiums determined?" below. You can also read the article "Where does your premium go?"

Each year, the insurer develops profiles of its patients, then figures out how much that type of patient will cost. For example, one profile might be for males, age two to six. The insurer will determine his average number of doctor visits, how many vaccinations he will need, how many times he might fall and need stitches, etc.

Using those profiles, multiplied by the number of patients they expect to cover, the insurer estimates what the costs will be. Then insurers find an average cost per patient or family.

If you get your health insurance through your employer, then you and you employer may share your premium costs. If you don’t get your health insurance through an employer, the entire premium is paid by you.

Huge medical expenses can be devastating. That’s why out-of-pocket maximums are put into your health plan. If you or a family member has a health crisis, and you reach your out-of-pocket maximum for the calendar year your insurance will cover you at 100% for the rest of that year. The out-of-pocket limit includes deductible, coinsurance and copay amounts. The out-of-pocket limit does not include premium payments or charges for non-covered services.

For example, if your out-of-pocket maximum is $10,000, when you meet this amount, your insurance will cover your services at 100%. Please note there are in-network and out-of-network out-of-pocket maximums. This means you may not pay for in-network services, but still receive a bill for out-of-network services.

Health Spending Accounts

Healthcare spending accounts (like health savings accounts, health reimbursement accounts and flexible spending accounts) are one of the best ways to save on healthcare costs. Watch to see how they work.

A health savings account is a special savings account that you can use to pay for approved healthcare costs. You or your employer can deposit money into this account. An HSA is a way for you to pay for your qualified healthcare expenses and save for future expenses on a tax-free basis.

A flexible spending account is an arrangement with your employer to pay for many of your out-of-pocket medical expenses with tax-free dollars. These expenses include copays, deductibles, qualified prescription drugs, insulin and medical devices. Typically, you are not allowed to keep unspent FSA funds.

Both account types allow you to set aside money for certain kinds of healthcare costs, also called "qualified expenses." Both accounts have tax benefits that allow you to stretch your healthcare dollars further, although those benefits aren’t the same. Take a look below to see how their benefit and requirements differ.

Health Savings Account (HSA)Flexible Spending Account (FSA)
RequirementsMust have a high-deductible health plan (HDHP)None
Contribution limit$3,400 individuals or $6,750 family$2,600
Changing contribution amountsChanges to your contribution can be made any time.Choose the amount you want to contribute for the year at open enrollment or with a change in employment or family status.
RolloverUnused money rolls over for the next year.Unused money does not roll over unless your employer has a grace period policy.
Connection to employerAn HSA bank account is yours; you take it with you when you change jobs (even employer contribution).AN FSA is set up and owned by your employer; you may lose it if you change employment unless you’re eligible for FSA continuation through COBRA.
Effect on taxesPersonal contributions to your HSA are tax-deductible. Contributions taken from your paycheck are before tax too.Contributions are pretax, and distributions are untaxed.

Healthcare spending accounts have rules for contribution limits, minimum deductibles, out-of-pocket maximums and unqualified medical expenses. To learn exactly what those rules are, view our article, "The Wild World of HSA Rules."

Pharmacy

Prospective and current members can view our list of covered drugs, or formulary, to see if a drug is covered. Coverage of these drugs depends on your policy.

You can use our pharmacy locator to find a pharmacy. You also can call the customer service number on the back of your member ID card for assistance.

Step therapy is a process that helps people save money by first using generic drugs in the first and second tiers to treat medical conditions. If the cheaper medicines are not effective then people move up (or “step”) in tiers to brand-name or higher-cost medications. To learn more about step therapy, read here.

Drug tiers are designed to save you money on your medications. Tiers represent different levels of cost. You will pay the least for medications in Tiers 1 and 2, which are usually generic drugs. All generic drugs are FDA-approved and equally as effective as brand-name drugs. In fact, they are typically the same medication. The cost savings you receive is because the drug is sold under its chemical name after the patent for the brand-name version has expired. You will pay more for drugs in the higher tiers, which are brand-name and specialty drugs. You can find cost information in your plan's list of covered drugs (also called formulary).