Commonwealth Care Member Guide - BMC HealthNet Plan

PREMIUMS AND CO-PAYMENTS
Some members may have a premium. A premium is what you must pay to the
Health Connector as part of the cost of your BMC HealthNet Plan coverage.
- You must send your monthly payments to the Health Connector. Call the Health
Connector with any premium questions.
- If you have trouble paying your premium, call the Health Connector. If you stop
paying, you may lose your coverage. Premium and co-payment hardship waivers
are available through the Health Connector for some enrollees. Call the Health
Connector with your premium questions. Their number is 1-877-623-6765.
A co-payment is what you pay directly to a healthcare provider for a health service
when you receive the service. There is an out-of-pocket co-payment maximum. This
means that you will only have to pay a certain total amount of co-payments each
year. Co-payments are usually due at the time of service.
DO NOT SEND MONEY TO
BMC HEALTHNET PLAN.
REFERRALS AND PRIOR-AUTHORIZATIONS
REMEMBER: YOUR PCP DELIVERS OR COORDINATES YOUR CARE.
REFERRALS TO PROVIDERS
- You always need a referral from your PCP to see an out-of-network provider.
Your PCP must call BMC HealthNet Plan to make sure that we approve the
referral. BMC HealthNet Plan may direct you to see a different provider.
- In some cases, you need a referral from your PCP before you see an innetwork
provider.
- You do not need to get a referral for most in-network OB/GYN services.
- If you need a referral in advance and do not get one, you may have to pay for
the services.
PRIOR-AUTHORIZATIONS FOR SERVICES
- Your PCP needs to get approval from us before referring you for certain
health services. This is called a prior-authorization.
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CALL MEMBER SERVICES AT 1-877-957-5300 IF YOU HAVE ANY QUESTIONS.