What type of plan do I have?

The Select Blue^® Network offers two types of health care insurance plans:

Preferred Provider Organization (PPO) plans
Exclusive Provider Organization (EPO) plans

To find out which plan you have, please see your plan materials or your Select Blue^® ID card, and look for either “Select Blue with PPO” or “Select Blue with EPO”.

Why is it important to know if I am in a PPO or an EPO?

Select Blue is a limited network—it does not include as many hospitals and doctors as you may be used to. It’s important to check if a doctor or hospital you plan to use is in the Select Blue Network, because:

If you have a PPO plan and you use a hospital or doctor not in the Select Blue Network, you may have to pay a higher portion of the cost yourself.
If you have an EPO plan and you use a hospital or doctor not in the Select Blue Network, you may have to pay all of the cost yourself.

What is the difference between Select Blue^® In-Network providers and Select Blue^® Out-of-Network providers?

Select Blue PPO plans separate providers into one of two groups: Select Blue In-Network providers and Select Blue Out-of-Network providers. Understanding the difference between the two provider groups will help you control your costs when you get care.

Select Blue In-Network providers:

Are the foundation of the Select Blue Network.
Are selected from the standard Blue Cross Blue Shield of Massachusetts network based on meeting quality, efficiency, and cost guidelines.
Help you control costs when they provide care for covered services in Massachusetts (your in-network benefits).

Select Blue Out-of-Network providers

If you have an EPO with Select Blue benefit plan:

Your plan does not provide benefits for services from doctors and hospitals that are not in the Select Blue Network. Getting care from an out-of-network health care provider will not be considered a covered benefit and will not be paid (except for urgent care or emergency care, when traveling outside of the service area, or when authorized by your health plan).

If you have a PPO with Select Blue benefit plan:

Your plan provides benefits for covered services from doctors and hospitals that are not in the Select Blue Network, but you will have to pay a higher cost share (your out-of-network benefits). In addition, you may be subject to balance billing if you receive care from a provider who is not found in the Select Blue Network Provider search tool. You can avoid balance billing by seeking care from either a Select Blue In-Network provider or a Select Blue Out-of-Network provider that is listed in this search tool.

Balance Billing

This is when an out-of-network provider bills you for the difference between his or her actual charge and the allowed charge (the amount we pay the provider based on your plan.) Select Blue In-Network providers and Select Blue Out-of-Network providers listed in the Select Blue Network Provider search tool are preferred providers. They will not balance bill you for covered services. Please note: doctors that are not listed in the Select Blue Network Provider search tool may balance bill you, even if they are part of the standard Blue Cross Blue Shield of Massachusetts PPO network.