This page shows employees’ in-network cost share amounts for certain services and benefits. It’s what they pay for care from a provider who is part of the BCBSAZ network. Their cost share and deductible will be higher if they get care from an out-of-network provider. Also, when they go out-of-network, they usually have to pay the difference between what the provider charges and the allowed amount (called “the balance bill”). For example: if an out-of-network hospital charges $1,500 for a service and the allowed amount is $1,000, they may have to pay the $500 difference, plus their out-of-network cost share.
This is only a brief summary of the benefit plans, and is designed to help you compare features of different plans. All plans are subject to limitations, exclusions and other cost share requirements not shown here. More detailed information about benefits, cost share, exclusions and limitations is in the benefit plan booklets and plan Summary of Benefits and Coverage (SBC), and is available prior to enrollment, on request. If the terms of this summary differ from the terms of the benefit plan booklets, the terms of the booklets control and apply.
* These plans are offered to employers considered "small" for purposes of the Affordable Care Act (ACA) and/or Arizona law:
- ACA -- the average number of total employees on business days during the previous calendar year is 50 or fewer
- Arizona law -- on a typical business day, 50 or fewer employees are eligible for health benefit plan coverage
† All of our plans are available with our extensive BCBSAZ statewide provider network. EverydayHealth and CopayComplete are also available at a lower cost with our High Performance Network, called “Alliance.” Within Arizona, Alliance Network providers are located primarily in Maricopa County and include hospitals and doctors that are part of Banner Health and Scottsdale Healthcare. If you choose the Alliance network, most Arizona in-network doctors and hospitals are located in Maricopa County. Doctors and hospitals in the Alliance network can deliver more integrated care because they are part of a smaller, more localized and more integrated network. This is how BCBSAZ lowers the cost of services, passing the savings on to you with lower premiums for plans paired with a High Performance Network.
‡We also offer these three plans, paired with our statewide PPO, through the Small Business Health Options Program (SHOP), a federally sponsored health insurance marketplace. Beginning in 2014, a Small Business Health Care Tax Credit is available to certain employers who purchase coverage through the SHOP.
§Each member has copay cost share for up to three in-network total PCP/Specialist office visits per calendar year. After three copays, coinsurance applies.