New York • POS, Traditional Indemnity, High-Deductible Health Plan (HDHP)
POS coverage under this prefix operates on a tiered system. Tier 1 (in-network with referral) provides the highest coverage. Tier 2 (in-network without referral) provides moderate coverage. Tier 3 (out-of-network) provides the lowest coverage. Verify which tier applies before submitting the claim.
This prefix includes traditional indemnity coverage. Indemnity plans are the oldest form of health insurance and offer maximum provider choice with no network restrictions. Members pay a percentage of charges after meeting their deductible. Reimbursement is based on reasonable and customary rates for the service area.
This is a High-Deductible Health Plan (HDHP) prefix. These plans have minimum deductible thresholds set by the IRS. Members often use HSA funds to cover out-of-pocket costs. The plan's claims processing and payer ID are the same as the standard plan, but expect higher patient responsibility amounts on remittance.
Part of the Blue Cross Blue Shield Association, serving New York members with commercial, Medicare and Medicaid plans.