Health Insurance Shopper’s Guide for you and your family.

Health Insurance Shopper’s Guide
3 steps to choosing the right health plan
for you and your family.
Ready to get started?
We’re here for you online, on the phone or in person.
Visit for a quick and free quote
Answer a few quick questions and our “help me choose”
tool will show you the best plan choices for you.
Talk to a knowledgeable insurance agent at 1-877-864-4899
They’ll help you find out if you can get a subsidy then find
the plan and the provider network that’s best for you.
Join us for a Health Insurance Seminar
Learn how insurance works and meet one-on-one with licensed agents
to get your questions answered and find the plan and network that’s best
for you. To register for a FREE seminar visit
Steps to
For Health
Choosing a health insurance plan
is an important decision. We’re
here to help make it easier to find
and sign up for health insurance.
Let’s get started!
Step 1
Get to know how insurance works.
When you have a health insurance plan, you agree to pay a monthly bill –
called a Premium – and your health insurance company agrees to share
in the cost of your medical care. Here’s a look at how you and your health
insurance plan may share healthcare costs. Your exact cost share may vary,
depending on the plan you pick.
Copay: Set amount you may pay to see a doctor,
visit an urgent care or fill a prescription.
You Pay
Fees vary
by service
of the cost
of service
Deductible: Amount you may pay before your
insurance starts sharing medical costs with you.
How it works:
Assume you have a plan with a $1,000 annual
deductible so you must pay the first $1,000 of
the costs.
Coinsurance: This is your share of the
healthcare cost after your deductible is met and until
you meet the out-of pocket maximum.
How it works:
Assume you have a plan with 80%/20%
coinsurance. That means once you have paid your
$1,000 deductible, your insurance will pay for 80% of
the costs and you will pay 20% of the costs until you
reach your out-of pocket maximum.
Per household
$325 per adult
$162.50 per child
Up to $975
per household
The most you
pay during a year before your health plan pays 100%
of the allowed amount for covered services.
Once you reach the maximum, you’ll still have to pay
premiums, but your health plan will cover the costs
for covered services the rest of the year so long as
you stay “in-network.”
The Affordable Care Act
requires most people to
have health insurance.
Those who don’t could
face federal tax penalties.
These penalties are
calculated for each
household in two ways
as shown below. You
have to pay whichever
amount is higher.
2015 Federal Tax Penalties
20% up to
Out-of-Pocket Maximum:
How it works:
If your plan has a $4,500 maximum, you’ll pay $1,000
for your deductible and an additional $3,500 in
coinsurance to reach your out-of-pocket maximum.
Penalties for
being uninsured
2% of
household income
Step 2
Find out if you can get financial help.
Think you can’t afford health insurance? There are two kinds of financial
help – called subsidies – from the federal government. These subsidies
are meant to help reduce your overall cost of health insurance.
We’re here to
help you
Premium Tax Credit
If you think you may be able
to get financial help, we can
help you apply for subsidies
through the Health Insurance
This helps pay for all or part of your monthly insurance bill (or “premium”)
Cost-Share Reduction
This helps pay your share of the costs of medical services you may receive
such as copays, deductibles and coinsurance
Subsidies are given to individuals and families based on their household
income and family size. You may receive subsidies by applying through
the Health Insurance Marketplace ( Here’s a look at the
net household income levels eligible for subsidies.
2015 Qualifying Income Levels
Number of people in your household
Qualify for lower premiums
if your annual income is
$29,176 –
$39,326 –
$49,476 –
$59,626 –
$69,776 –
$79,926 –
Qualify for lower premiums
and out-of-pocket costs if your
income is between…
$16,105 –
$21,708 –
$27,311 –
$32,914 –
$38,516 –
$44,119 –
There’s Also Medicaid
Medicaid is a federal government program that provides health coverage for low-income individuals. You
can apply for Medicaid coverage at any time of the year. You can find out if you get Medicaid by calling the
AHCCCS hotline at 1-855-432-7587.
Step 3
Pick a plan and pick a network.
Pick a plan that fits your budget and lifestyle
Choosing the right plan comes down to health and budget. Here are
some questions to ask as you pick a health plan:
5 Questions to Consider
1. What plans offer affordable copay amounts for doctor visits?
2. Are my medications covered?
3. Which plans does my doctor take?
4. What deductible is right for my budget?
5. Which plans offer the best value?
All of our plans have
coverage for:
Doctor visits
Prescription drugs
Preventative care,
screenings and
Outpatient care
Emergency and
urgent care visits
Hospital stays
Mental and behavioral
health care
Pregnancy and
newborn care
Children’s dental and
vision care
All plans are subject to limitations,
exceptions, and cost share requirements.
BCBSAZ Plans for 2015
Here’s a look at our plans available as PPO plans across the state and
HMO plans in Maricopa and Pima Counties.
Most popular!
EverydayHealth may be the right plan for you and your family if you:
• Want low copays for in-network doctor visits and prescription drugs
• Need financial protection in case you have an emergency or a major
medical issue
• Want broad coverage, but don’t want to pay too much each month
Which Metal
Level is right
for you?
Gold Plans
• Want to know exactly what you will pay if you need a surgery or major
medical treatment
• Want in-network coverage right away without having to pay a deductible first
• Are willing to pay a little more each month to get predictable costs if
a major medical situation arises
Willing to pay more each
month for the peace of mind
of knowing out-of-pocket
costs will be more limited
$0 deductible in-network!
CopayComplete may be the right plan for you and your family if you:
Under 30s!
SimpleHealth may be the right plan for you and your family if you:
• Are under age 30 or have met a hardship exemption
• Are likely to visit your doctor less than four times in a year
• Want the absolute lowest possible monthly premium, even if that means
you may pay more if you do to get medical care
Lowest Deductibles/Highest
Monthly Premiums
Medium Deductible
Amounts/Medium Monthly
Want broad coverage with
more moderate monthly and
out-of-pocket costs
• Are likely to visit the doctor less than four times in a year and stay in-network
• Are likely to choose generic prescription drugs over brand-name drugs
• Are willing to pay more if you do need medical services, in return for a
lower monthly premium bill
Looking for the lowest
monthly premium
Low premiums!
Essential may be the right plan for you and your family if you:
Portfolio HSA
HSA ready!
Portfolio HSA may be the right plan for you and your family if you:
• Want to pair your health plan with a Health Savings Account
• Don’t expect frequent doctor visits or prescriptions, or
• Are expecting higher medical costs and want to use a Health Savings
Account for its tax advantages
Highest Deductible/Lowest
Monthly Premium
Monthly Premium Out-of-Pocket Costs
Pick a network of providers to visit.
A big part of choosing an individual and family health plan is picking your
healthcare provider network. A network is a group of doctors, hospitals
and other medical service providers that agree to provide services to
members of a health plan. When you see doctors that are contracted
with your plan, they are considered to be “in network.”
Blue Cross
Blue Shield of
Arizona Network
Our Network options† include:
• Statewide PPO
Why Network Choice is Important
by choosing a smaller network.
Includes over 90% of the
doctors and hospitals in
Arizona,†† including doctors
and hospitals in every county
• Your medical costs will be lower if you get care from an in-network doctor.
• Alliance HMO
• Some plans cover only limited services out-of-network, such as
(Maricopa County only)
You may be able to save money on your monthly payment (premium)
5 Questions to Consider
1. Is my doctor in-network?
2. Are there in-network doctors and hospitals close to where I live or work?
3. Do I often travel outside of my home county?
4. Am I willing to have a smaller choice of doctors and hospitals if it would
save me money?
5. Do I need to get care from doctors and hospitals outside of the network?
† Networks are subject to change.
†† Internal Company data representing BCBSAZ’s statewide network only. Does not apply to any other BCBSAZ network.
Includes doctors and
hospitals from Banner Health,
Scottsdale Healthcare and
John C. Lincoln Health
• Select HMO
(Maricopa County only)
Includes doctors and hospitals
from IASIS Healthcare, Dignity
Health and Phoenix Children’s
• Secure HMO
(Pima County only)
Includes doctors and
hospitals from Carondelet
The Statewide
PPO network
is available to
Arizona residents
Maricopa County residents
can choose the Statewide PPO
or from two Exclusive HMO networks
Pima County residents
can choose the Statewide PPO
or one HMO network
Open Enrollment
November 15, 2014 – February 15, 2015
Get Answers.
Get Covered.
Open Enrollment is the set time period when you can
buy individual health insurance plans for yourself or your
family. This is the only time during the year that you can
enroll in an individual health insurance plan, unless you
have a Qualifying Event.
Special Enrollment Period
If you did not get enrolled during the Open Enrollment
Period you can still get enrolled if you have a Qualifying
Event. Events include marriage, birth of a child, change
of jobs and more. For a list of common qualifying events,
Six Reasons to
Choose Blue
We know you have many choices today when it comes to
health insurance. As you compare health insurance plans, think
about what Blue Cross Blue Shield of Arizona offers.
Trusted experience
Great value
Trust in a name that has been protecting Arizonans for 75
years, with over 1.3 million customers1.
Members of our plans also get access to convenient account
tools and other member programs. The AZblue mobile
app and online tools help you manage your account, plus
members also gain added value through wellness programs,
such as Walking WorksTM, savings for gym memberships
and more.
Healthcare your way
With network choices, including a Statewide PPO network with
more than 90% of doctors and hospitals in Arizona1, as well as
more local HMO networks with a smaller number of providers in
a more narrow area, you can decide what works for you.
We make it easy
Freedom to choose
High satisfaction
J.D. Power ranked us “Highest
in Member Satisfaction among
Commercial Health Plans in the
Southwest Region.” *
We’re here for you every step of the way. Whether you need
help finding a plan, applying for subsidies or help finding a
doctor, we have people you can talk to. We also have Spanish
speaking sales representatives available to assist you too.
Compare plans that fit different needs and budgets. And
choosing a local network may offer more savings too.
We were rated by J.D. Power as having the “Highest
Member Satisfaction among Commercial Health Plans in the
Southwest Region.”*
Internal company data
* Blue Cross Blue Shield of Arizona received the highest numerical score among commercial health plans in the Southwest region (AZ, NM, NV) in the proprietary J.D. Power 2014
U.S. Member Health Plan StudySM. Study based on 34,315 total member responses, measuring seven plans in the Southwest region (excludes Medicare and Medicaid). Proprietary
study results are based on experiences and perceptions of members surveyed December 2013-January 2014. Your experiences may vary. Visit
When can you enroll?
Open Enrollment
November 15, 2014 – February 15, 2015
Special Enrollment Period
For more information about the
Special Enrollment Period visit
Get answers.
Get covered.
Call Blue Cross Blue Shield of Arizona today.
hablamos español
D11568 10/14
P.O. Box 13466, Phoenix, AZ 85002-3466