Frequently Asked Questions

Benefits

I just got coverage with Health Advantage. What do I do now?

You can do a few things right away to get the most from your health plan:

• Put your new member ID card in your wallet or in another safe place.
• Sign up for Blueprint Portal It’s our members-only website where you can estimate treatment costs, review and rate doctors you have seen, view your claims and more.
• Use our Find Care tool on Blueprint Portal to find a primary care provider (PCP). Your PCP is the doctor you should see first for routine medical care. You can change your PCP at any time.
• Schedule an annual wellness visit with your PCP. An annual wellness visit is free to you. Plus, it’s a good opportunity for your doctor to get to know you.
• Download our mobile app It gives you instant, on-the-go access to your electronic member ID card. With our mobile app, you can access our Find Care tool, along with maps, customer service support and more. You can even pay your bill through the app.

What does my health plan cover?

There are several ways to find out what your health plan covers:

• You can refer to the statement of benefits that you received when your policy began.
• Or you can call the customer service number on the back of your ID card.
• Another way is to sign in to our self-service web portal, Blueprint Portal.
• Find out which procedures are covered by your policy using this online search tool.

What is the difference between in-network and out-of-network benefits?

Your coverage is based on pricing arrangements we have with our network of healthcare providers. Getting care from providers in that network almost always saves you money. Generally, in-network benefits and services are provided at lower rates than out-of-network benefits and services. That’s because we contract with most doctors and hospitals (in-network providers), but don’t have contracts with others (out-of-network providers). Out-of-network providers usually charge more, so you usually end up paying more.
If you receive care from a doctor or hospital that is out-of-network, you still benefit from having insurance. However, you won’t get the lower cost that we negotiate with in-network providers, meaning you will pay more out-of-pocket.

Any time you get a referral to a specialist, it is good to make sure he or she is in-network. You can call customer service to find out if a doctor or hospital is in-network, or you can use the Find Care tool. Find out more about staying in network.

What is the difference between a preventive and diagnostic test?

Preventive screenings look for diseases or conditions before there are symptoms or signs. Diagnostic tests are done when you and your doctor know you have a health problem and you need to know the cause. Preventive screenings, when run as part of an annual wellness visit, often are covered at no cost to you. If you need diagnostic tests, you will likely pay for a portion of the test, according to your benefits (deductible, copay, coinsurance, etc.) To learn more about the two, visit our article "Preventive vs. Diagnostic. What's the difference and why the cost?".

Why doesn't my policy include dental and vision?

If you don’t have dental or vision coverage, and you would like to get it, don’t fret; we can help. Health Advantage also offers individual and family dental and vision products in our Shop section. Call one of our agents at 800-392-2583 to discuss your options.

Payments

How can I pay my monthly premium?

Health Advantage offers several convenient ways (online, with our smartphone app, by phoning customer service, in person, etc.) to pay your monthly premium, and you can make it even easier with autopay.

Can I pay my monthly premium at one of the ArkanasBlue stores?

Yes. If you get your insurance through an individual plan, you can pay by check, money order or cashier’s check at an Arkansas Blue Cross location near you. For your protection and ours, we do not accept cash payments at our locations. We do not charge a transaction fee for payments.

Why do I get a EOB?

Depending on the coverage you have, you'll receive either a Explanation of Benefits (EOB) each time you visit a doctor, so you can keep track of your healthcare spending. It's not a bill but a guide for how to review a bill if your doctor sends you one. You also can see your claims history in our secure, members-only website, Blueprint Portal.

Cost

How do premiums, deductibles, copays and coinsurance work?

Premiums are the fixed amount you pay each month for your health insurance coverage. It’s your monthly bill for your health insurance, similar to a monthly payment for car insurance.

A deductible is the amount you pay for medical costs before your health insurance begins to make payments. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1,000 deductible for allowable charges, not the billed charges. An “allowable” charge is the amount Health Advantage agrees to pay for a particular healthcare service. The amount reflected on a healthcare provider’s bill may be more, but your deductible is based on the “allowable” charge. Also, you may have a deductible for each person on your policy and one for your family as a whole.

Copayments (copays) are a fixed amount you pay, usually at the time of a medical service. Copays are separate from, and do not count as part of, your deductible. However, they do count toward your out-of-pocket maximum, which can help if you have high medical expenses during a calendar year. Your copay can vary, depending on the type of service you receive (for example, a copay for seeing a specialist may be more than a copay for a primary care visit). You also may have a copay when you get a prescription filled.

Coinsurance is the percentage of the cost you are responsible to pay for healthcare services, after your deductible has been met. For example, you may pay 20% for a service, and your insurance may pay 80%.

How does my deductible affect my premium?

Plans with a higher deductible usually have a lower monthly premium, and plans with a lower deductible usually have a higher monthly premium. It is important to select a health plan that matches your needs and budget. If your health plan doesn’t seem like a good fit for you, talk with one of our agents during the next Open Enrollment Period. Call 800-392-2583.

Is my copay applied to my deductible?

No. Copays do not count as part of your deductible.

Why do I pay a deductible when I'm already paying a premium each month?

A premium is your monthly bill for health insurance coverage – similar to a monthly payment for car insurance. A deductible is the amount you pay for medical costs before your health plan begins to make payments.

Why does my premium go up every year even when I don't submit any claims?

The cost of healthcare keeps increasing – much more than other costs. This high healthcare inflation affects premiums. Health Advantage is working to find ways to hold down the cost trend for everyone. We have focused on reducing low-value services in the healthcare system, using technology to create efficiencies and promoting transparency and rewarding evidence-based care. To understand how health insurers determine annual premiums, see the question "How are premiums determined?" below.

How are premiums determined?

Each year, we develop profiles of members, based on age and gender. We then look at claims data to figure out how much that type of member will cost, based on the average number of doctor visits and health risks we see for members of the same age and gender. Using those profiles, multiplied by the number of covered members, we estimate what the costs will be for the upcoming year. Then we find an average cost per patient or family.

How do out-of-pocket maximums work?

Huge medical expenses can be devastating. That’s why out-of-pocket maximums are put into your health plan. If you or a family member has a health crisis, and you reach your out-of-pocket maximum for the calendar year, your insurance will cover you at 100% for the rest of that year. The out-of-pocket limit includes your deductible, coinsurance and copay amounts. The out-of-pocket limit does not include premium payments or charges for services that are not covered. For example, if your out-of-pocket maximum is $10,000, when you reach this amount, your insurance will cover your services at 100%. Please note that there are in-network and out-of-network out-of-pocket maximums. This means you may meet your out-of-pocket maximum for in-network services, but if you receive out-of-network services and have not met that deductible, you still may receive a bill.

Health Savings Accounts

What is a health savings account?

A health savings account is a special savings account you can use to pay for approved healthcare costs. You or your employer can deposit money into this account. An HSA is a way for you to pay for your qualified healthcare expenses and save for future expenses on a tax-free basis.

What are the rules about health savings accounts?

Health savings accounts have rules for contribution limits, minimum deductibles, out-of-pocket maximums and unqualified medical expenses that can change yearly. To learn more about HSA-eligible plans on the Health Insurance Exchange, go to the healthcare.gov glossary on HSAs.

Pharmacy

How do I know if my prescription drug is covered?

You can view our list of covered drugs, also called a formulary. Our formulary shows all of the drugs Health Advantage covers under all of its health plans. View your specific health plan to see which drugs we cover under that plan.

How can I find a pharmacy?

You can use our pharmacy locator to find a pharmacy. You also can call the customer service number on the back of your member ID card.

What is step therapy?

Step therapy helps patients save money by first trying generic drugs to treat medical conditions. Generic drugs are approved by the Food and Drug Administration (FDA) and are just as effective as brand-name drugs. Sometimes a patient may not respond well to a medication (brand-name or generic) and will need to try something different. In step therapy, if that is the case, the patient can ask to move up (or “step”) in tiers to another brand-name or higher-cost medication. You can learn more about step therapy, in our Pharmacy section.

How do drug tiers work?

Drug tiers represent different levels of cost and can save you money on your medications. You pay the least for medications in tiers 1 and 2, which usually are generic drugs. All generic drugs are FDA-approved and are just as effective as brand-name drugs. In fact, they typically are the same medication, with identical active ingredients. Patents for brand-name medicines give drug companies the ability to market a drug for a period of time without direct competition. When these patents expire, generic versions (usually called by their scientific names) can come on the market, often at much lower prices. You will pay more for drugs in the higher tiers, which are brand-name and higher-cost specialty drugs. You can find cost information in your plan's list of covered drugs (also called formulary).