This prefix is linked to a POS plan. Point of Service coverage gives members a choice at the time of service: use the HMO-style in-network benefit with a referral for lower costs, or access out-of-network providers at reduced coverage levels. The billing approach depends on which option the member chooses.
This prefix is associated with a High-Deductible Health Plan. HDHP members pay more out-of-pocket before insurance coverage begins. These plans are commonly paired with HSA or HRA accounts. When billing, be aware that the member may have significant cost-sharing responsibility until their annual deductible is satisfied.
HMO (Health Maintenance Organization) plans require members to choose a primary care physician (PCP) and obtain referrals before seeing specialists. Out-of-network services are generally not covered except in emergencies. Claims must be submitted to the payer listed above and should include referral authorization when applicable.
Independent licensee of the Blue Cross Blue Shield Association providing commercial, Medicare and Medicaid plans in Idaho.