Tiered Networks: How They Work

Learn how tiered-network plans offer access to high quality care while saving money.

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Every health insurance plan covers a network of doctors, providers and hospitals. You’ve probably heard the terms “in-network” or “out-of-network.” Those are the two categories that describe whether providers are covered or not.

A tiered network works differently.

A “tiered” network plan has different levels with varying costs. The Preferred health system is tier one and has the lowest out-of-pocket costs. At each level, the out-of-pocket costs increase.

DakotaBlue | Altru is a BCBSND tiered network product. The plan is available in 11 North Dakota counties served by the Altru Health System and a Preferred network of providers and incentivizes care within that system.

In addition to cost savings, DakotaBlue | Altru supports high-quality care from well-connected, collaborative providers within the same health system.

Find more specifics on the DakotaBlue | Altru product page.

Using a tiered network plan

Where most health plans categorize providers into two categories (in-network or out-of-network), DakotaBlue | Altru has four different levels:

Preferred Network: Includes clinics, doctors and hospitals in North Dakota's Altru Health System and a Preferred network of providers. Deductible and out-of-pocket expenses are lowest within this network.
Enhanced Network: Includes North Dakota providers who accept Blue Cross Blue Shield (BCBS) plans. Deductible and out-of-pocket expenses are higher than within the Preferred Network.
Standard Network: Providers outside of North Dakota who accept BCBS plans. Deductible and out-of-pocket expenses are higher than within the Enhanced Network.
Non-Participating Provider: Includes all other providers who do not accept BCBS plans, both inside and outside of North Dakota. Deductible and out-of-pocket expenses are highest with Non-participating providers.

NOTE: Occasionally, Preferred Network providers refer patients to doctors in the Enhanced or Standard network. Those services may be covered if the referral is approved and the provider accepts BCBS insurance plans.

Benefits of a tiered network plan

There are two major benefits to a tiered network plan—quality of care, and cost of care.

Cost savings and quality come in part from focusing on a single health system where providers can easily share health records, test results, treatment plans and avoid duplication of services.

Quality of care

Seeing providers within the same health system, such as Altru, ensures that doctors have easy, quick access to all of a member's information--such as medical history, care routines and more. This allows them to make more informed, collaborative care decisions.