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Benefits are the services that get paid for by your health insurance company. All health insurance plans cover essential health benefits, which include emergency care, mental health and substance abuse, maternity and newborn care, prescription drugs, lab tests, preventive services, and pediatric services.

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This is the amount you pay your insurance company each month (not what you pay at the Doctor or pharmacy). Prices can vary by location and family size, but you can’t be charged more based on your gender or if have or have had health problems in the past. In general, the lower your monthly premium the more you will pay when you receive health services.

How much does it cost?
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Copays, Deductibles, Coinsurance

Every plan involves cost sharing—the amount you pay when you get a service and the amount your insurance company pays. Every plan also has an out-of-pocket maximum which is the most you would ever have to pay for services in a plan year. If your out-of-pocket maximum is reached, your insurance company picks up the balance of the allowed expenses as long as you continue to pay your monthly premium.

What’s the price difference?
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Health Savings Accounts

An HSA is a tax-free funding account owned by you that helps you pay for qualified medical expenses such as lab fees, prescription drugs, contact lenses, chiropractor visits and more. HSAs can only be used with certain High Deductible Health Plans (HDHP).

Learn more about HDHP
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Flexible Spending Accounts

A Flexible Spending Account (FSA) offers a smart, simple way to set aside money tax free to cover the everyday expenses you know you'll have in the coming year. You can use it to pay for eligible non-covered medical or dental expenses, child care, and even dependent adult care costs.

How to save with an FSA
Asset 1Dear Laura,After seeing your primary doctor on January 5, 2017, you owe $50.00 for the prescription that was prescribed.If you have questions before your coverage start date, please give our Customer Care a call at 1-800-339-7753.Thank you for choosing Excellus BlueCross BlueShield.


When you receive medical care or need a prescription, your provider or pharmacy sends a claim to the insurance company. Depending on your plan benefits, how much the insurance company will pay and how much you will pay is determined through the claims process. A monthly explanation of benefits (EOB) is sent to you so you can see the services and costs of those services.

Learn more about claims