Health Insurance 101

If your health plan has a deductible, it is the amount you pay for most covered services before your health plan starts to pay. With other types of insurance (such as for your car), you usually pay the full deductible in a lump sum when you need a repair. With health insurance, the deductible adds up each time you get care until you reach the annual amount.

• In-Network vs. Out-of-Network Deductibles: The difference between in-network and out-of-network deductibles is based on whether your doctor has a contract with your health plan. If your doctor is not contracted with your health plan, the cost of the services you get will count toward the out-of-network deductible. The cost of these services is often higher, which means you may pay more out-of-pocket.
• Timeframe: Your health plan deductible resets at the beginning of the calendar year or when you enroll in a new plan. It’s a good idea to keep track of it. If you’ve met your deductible for the year, or are close to meeting it, you may want to squeeze in planned tests or other care before your plan year ends to lower your out-of-pocket costs. Log in to Blue Access for Members^SM, your online account, to view your deductible and out-of-pocket amounts.

Most preventive services are not subject to the deductible. The plan pays for these services regardless of your deductible, which means there is no cost to you. Examples of preventive services include:

• Annual checkups
• Screenings for cholesterol, blood pressure, body mass index (BMI), weight and other adult recommendations
• Immunizations/vaccines for adults and children
• Counseling to prevent illness and disease

If your plan covers your family, there will probably be an individual deductible for each person and a separate family deductible. When an individual reaches their annual deductible, the plan starts paying for that individual. The individual deductibles also add up and count toward meeting the family deductible. As soon as the family deductible is met, your plan starts paying for everyone on the plan, even if each family member has not met their individual deductible. 

Here’s an example:

Your family gets in a car accident. You all need to get checked at the hospital for injuries. With an individual deductible, each person would pay their own deductible amount before the plan begins paying.

With a family deductible, when the amount is met (from care received by one or more family members), the plan begins paying for all family members. After the deductible is met, you are responsible only for the copay and/or coinsurance amount for covered services for the remainder of the plan year.

A copay is the dollar amount you pay out-of-pocket for a covered health care service at the time you get care or when you pick up a prescription drug.

Coinsurance is the percentage of the cost of a covered health care service or prescription drug you pay out-of-pocket after you've met your deductible. You pay 100% of the full allowed amount of covered services until you meet your deductible. 

Let's say you've met your annual deductible, so your plan now provides benefits for covered services. How much you pay depends on the percentage (coinsurance amount) that your plan pays for covered medical services after your deductible is met.

For example, you bruise your hip in a fall and you need an X-ray. If your plan’s coinsurance covers 80%, here's how the costs would break down:

• The total X-ray cost is $200.
• Your plan covers 80 percent, which is $160.
• Your out-of-pocket cost, or coinsurance, is $40.

The out-of-pocket maximum is the most you have to pay out of your own pocket for eligible covered medical services under your insurance plan during a plan year. Your deductible, coinsurance, copays and other eligible health care expenses will apply to either the in-network OOPM or out-of-network OOPM (if out-of-network benefits are applicable to your plan).

Depending on your Boeing plan, you may also need to meet a separate pharmacy out-of-pocket maximum. This means that your prescription drug expenses will be counted towards your separate pharmacy out-of-pocket maximum. Once you reach your OOPM, that is the most you will have to pay for that plan year if the prescriptions are eligible for coverage.

The allowed amount is a contracted rate that an in-network provider is allowed to charge. For example, if a service costs $150, and the allowed amount is $100, an in-network provider can only bill for $100. Please be aware that an out-of-network provider is not subject to the same rule. In this example, an out-of-network provider could bill $150. The health plan would pay the allowable amount of $100, and you would be responsible for paying the additional $50.

Your EOB lets you know when and how we process your claims. It isn’t a bill. It gives you a detailed look at the covered services and shows how much you may owe your provider after we apply your benefits. Your EOB also includes a list of insurance terms that explain deductible, copay, coinsurance, amount billed, amount covered and many more.

Locate providers based on your plan selection. For more personalized results, log in to Blue Access for Members^SM, your online account. Or call Boeing Member Services at 1-888-802-8776 for help locating an in-network provider.

It’s important to see an in-network provider to get the highest level of benefits, but certain Boeing plans offer out-of-network coverage. The cost of out-of-network services are generally higher, which means there is a higher member responsibility (more out of your pocket). A provider that does not have a contract with your health plan is called a non-participating provider. The services you receive from a non-participating provider apply to your out-of-network deductible and out-of-network out-of-pocket maximum.

No. Boeing’s medical plans with BCBSIL do not require referrals.

With a HDHP, you must pay your medical costs before your health plan does. Here’s an example. With a PPO and an HMO, you typically have a copay when you visit a doctor. Extra covered medical costs that occur from that doctor visit are covered by your health plan. With a HDHP, you must pay medical costs up front to reach your deductible amount before the health plan starts paying its part of covered medical expenses.

If your average year involves visiting a doctor for an annual exam, a well-woman exam and a nasty cold, a HDHP may make economic sense for you over the course of the year.

A HDHP is a health insurance plan with a high deductible. You pay a higher amount out of pocket before your insurance starts paying. While that may not be attractive to some people, some members with a HDHP actually pay lower monthly premiums than they do with a PPO.

To help you pay for your medical expenses, the HDHP plan comes with a pre-tax health savings account (HSA) dedicated to qualified medical expenses to which you can contribute as much or as little as you like within IRS guidelines.

For Boeing active employees that elect and are eligible for HSA, Boeing may contribute a sum towards HSA.

HealthEquity is the administrator of your HSA through Boeing. Visit HealthEquity and select ”Learn more about HSAs” for additional information.

You can review your Summary of Benefits and Coverage or call Boeing Member Services at 1-888-802-8776.

If you receive services from an in-network doctor or facility, they will file your claim for you. If you see an out-of-network doctor or facility, you may be responsible for submitting a claim. 

Get claim and other forms.

To file a claim electronically, log in to Blue Access for Members^SM, your online account, to send a secure message and attach your claim form and receipts. Or call Boeing Member Services at 1-888-802-8776 for help.

You can log in to Blue Access for Members^SM, your online account, to check the status of your claims or call Boeing Member Services at 1-888-802-8776 for help.

You can log in to Blue Access for Members^SM, your online account, to check your remaining balance on your deductible or call Boeing Member Services at 1-888-802-8776 for help.

BCBSIL uses clinical review criteria to make sure you get the health care you need. Our doctors and staff make decisions about care based on need and benefits.

Medical policies are also used to guide care decisions. These clinical standards help us decide what may be covered by a health plan. In-network providers usually handle the prior authorization process for you, but it's always a good idea to check with your doctor to find out if a prior authorization was completed.

A screening is considered preventive care. Annual physical exams, cholesterol level checks, mammograms, colonoscopies, Pap tests and other recommended preventive care are all screenings. Diagnostic tests may be done if something unusual is found during a preventive screening. Diagnostic tests are subject to the deductible and other cost sharing such as coinsurance and copays.

Preventive services don’t count toward your deductible. Boeing plans fully cover preventive services with in-network providers, which means you don’t pay anything out-of-pocket when you get them. Preventive services with out-of-network providers are not covered. If you receive care that isn’t covered by your health plan, it often won’t count toward your deductible. This might include services like a cosmetic procedure or seeing a provider who isn’t in your health plan’s network.

When you have a routine visit (also known as preventive care) with an in-network provider, only certain services are covered at 100%. If you have other services performed, or to talk with the provider about other issues that are not routine, you may be charged for them. 

Professional and facility services are billed separately in health care because they represent different components of the care provided. Professional fees cover the services of the physician or other health care provider, while facility fees cover the costs associated with the physical space, equipment, supplies and support staff used during the patient’s visit.