Tips for Maximizing Your Benefits

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From understanding your benefits to strategically planning procedures, we've got you covered with tips to help you maximize your health plan and save money on health care.

Our health plans offer a wide range of benefits and programs to help you and your family live better, healthier lives. We want our members to get the most out of their health plan, so in this article we will provide tips for maximizing your benefits. We will also give you some advice to save money on health care.

Understand Your Policy

To maximize your health plan’s benefits, you first need to know what they are. Typically, we mail you an outline of coverage each year summarizing your plan’s benefits. It also displays costs (deductibles, copayments, and/or coinsurance) you could be responsible for. Taking a few minutes to review the outline of coverage will help you better understand your benefits and how to take advantage of them.

Even if you renewed your previous policy, it is a good idea to read through the outline of coverage to refresh your memory and see if there is anything new, as plan costs can change from year to year. You may find your plan has benefits that apply to a recent change in your health. If you don’t have your outline of coverage, you can access it through our Member Resource Center (MRC). If you don’t have an MRC account, you only need your member ID card to register.   

Schedule an Annual Checkup 

During an annual checkup, you and your primary care provider (PCP) will discuss your medical conditions and what you can do to improve them. Your PCP will also review with you the preventive services you’re eligible for. Getting an annual checkup is a great way to ensure you’re doing all you can to be healthy. Your plan may cover the checkup at no cost to you.

Having a PCP is important for maximizing your benefits. They can coordinate your care and make sure you’re getting the most effective treatment. If you don’t have a PCP, use our Find a Doctor tool to locate one near you. Once you’ve selected a PCP, contact them to make an appointment for your annual checkup. 

Stay Current with Preventive Services

There are dozens of preventive screenings available — everything from abdominal aortic aneurysm to weight control. Some services may even be available at no cost to you. You should work with your PCP to determine which preventive screenings are right for you, based on your gender, age, and risk factors. Check out our blog article on 12 common preventive screenings and learn more about preventive care benefits on our website. 

See Your Doctor for $0

Many of our qualified health plans (QHPs) offer a certain number of zero-dollar office visits, where you can see an in-network primary care, mental health, or substance use disorder treatment provider with no cost-sharing. If your plan includes zero-dollar office visits, you don’t have to wait until you’re sick to use them — you can schedule an appointment to discuss how to improve your health. Take a look at our article on zero-dollar office visits for more details.

Use In-Network Providers

Seeing a provider in our network is an excellent way to maximize your benefits. That’s because we’ve negotiated rates with network providers. These allowed amounts are typically less than what an out-of-network provider would be willing to accept for the same services. For some of our plans, using a network provider is required to receive benefits. To find a network provider, either local or nationwide, please use our Find a Doctor tool. 

Connect With Telemedicine

Our members have access to several telemedicine platforms, including Amwell, SonderMind, and Valera Health. These telemedicine services offer convenient access to care, wherever you are. They also offer mental health support services for many conditions. Learn more about our benefits for telemedicine care.

Strategically Plan Procedures

If you know you’re going to have a big medical procedure and have some scheduling flexibility, you may want to strategically plan when to have it. Some people time procedures to maximize their benefits. To do this, you’ll need to know:

  • Do I have benefits for the service?
  • What is my deductible?
  • What is the most I can pay for this service? 

To understand your benefits, you can review your outline of coverage or call our customer service team to discuss in more detail.

Once you know your benefits, consider what would work best for you. For example, a person who knows they’re going to meet their deductible may choose to wait to have an eligible procedure until after the deductible is satisfied, so the plan will cover the procedure’s cost. Others who aren’t sure they’ll meet their deductible may opt to go ahead with an eligible procedure earlier in the year, so that the procedure’s cost can be used to meet the deductible. That gives them peace of mind that the rest of their eligible services for the year will be paid by their plan.

File and Review Your Claims

If you want to be sure you’re getting everything you should from your health plan, it’s a good idea to learn how to file a claim, if necessary. Vermont in-network providers are required to submit claims on your behalf. If a member has out-of-network benefits or an out-of-network prior approval, they may need to file a claim. In those cases, download our claim form and submit it to us for reimbursement. Be sure to get an itemized receipt, as you’ll need this to file a claim.

Another good habit to get into is checking your claims in the MRC before paying a provider’s bill. By looking at the summary of health plan payments (SHPP), you’ll see what the provider billed us, what the allowed amount is, what we paid, and the amount you owe (if any). Comparing your SHPP to a provider’s invoice ensures you’re paying the correct amount. 

Shop Around for Care

There’s often a wide range of prices among providers for the same service. Pharmacies can also vary in pricing for a prescription drug. You may benefit from shopping around to compare prices. Hospitals and other healthcare facilities are now required to publish prices on their websites. 

Open and Use an HSA

If you have a qualifying plan, such as a high-deductible health plan, opening and using a health savings account (HSA) is a great way to boost your benefits. You can use an HSA to set aside money tax-free to pay for many health-related expenses. Using an HSA to pay out-of-pocket expenses can produce significant tax savings. To find out more, check out our blog article on everything you need to know about HSAs

Check Out Member Discounts

Our members receive discounts at dozens of Vermont businesses on everything from acupuncture to yoga therapy. Take a look at our member discount list, which you can filter by location and category to quickly find deals in your area.

Participate in Wellness Programs

Many of our members are eligible to participate in our Be Well Vermont wellness platform, which offers assistance and guidance on things like nutrition and stress management. Using the Virgin Pulse app, you can take a health assessment and receive personalized recommendations, track your progress on wellness goals, and participate in fun fitness and wellness challenges. Learn more about our new wellness platform and mobile app

Get Help Managing Your Health

Managing your health can be complex, but you don’t have to go it alone. Our members have access to personal health support services, where Blue Cross Vermont registered nurses and licensed clinicians get to know you and provide personalized guidance. Among the issues they can help with are addiction, cancer support, and end-of-life care. Our Better Beginnings maternal health and wellness program helps expectant mothers receive comprehensive care and timely support. These services are available to members at no additional cost. For more information, check out our blog article on additional benefits.