What’s a tiered-network health plan?

Some North Dakotans have access to tiered-network health plans from BCBSND. How do these work?

Every health insurance plan covers a network of doctors, providers and hospitals. You've probably heard about doctors being "in-network" or "out-of-network."

With a tiered network, there are four different levels of coverage with different groups of providers. At each level, the out-of-pocket costs increase.

Currently available tiered-network plans

There are three tiered-network plans available in different parts of North Dakota:

• DakotaBlue | Altru is available across 11 counties in the Grand Forks area. It offers the lowest costs for providers in the Altru Health System.
• DakotaBlue | Trinity is available across 11 counties in the Minot area. It offers the lowest costs for Trinity Health providers.
• DakotaBlue is available across 3 counties in the Fargo area. It offers the lowest costs from providers in the Preferred Network including Essentia Health.

Using a tiered-network plan

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

1. Preferred Network: Includes clinics, doctors and hospitals in a specific local provider system. Deductible and out-of-pocket expenses are lowest within this network.
   
2. 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.
   
3. Standard Network: Providers outside of North Dakota who accept BCBS plans. Deductible and out-of-pocket expenses are higher than within the Enhanced Network.
4. 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

On average, premiums within DakotaBlue plans are 15% lower than comparable plans with more traditional network structures.

Seeing providers in the Preferred network does more than lower costs. It can help you get better, more efficient care. Doctors in the same system can more easily communicate with each other, share information and follow your care plan.

Verify the network before a visit

An easy search helps plan participants decide where to get care within their Preferred network. You can search by:

• Your provider name to see their associated network level
• A specialty to find available doctors within the Preferred network
  

Search for DakotaBlue | Altru doctors and specialties

Search for DakotaBlue | Trinity doctors and specialties

Search for DakotaBlue doctors and specialties

DISCLAIMER: Grandfathered health plans offered by some employers cover preventive care differently than these illustrations. See your benefit plan documents for coverage details.