You Have Health Insurance, Now What?

+ Where's my BMC HealthNet Plan Member ID Card?

You will be receiving your ID card and Welcome Kit in the mail. Remember to bring your ID card to all of your doctors' appointments and whenever you pick up prescriptions.

+ What should I do in an emergency?

In an Emergency (inside or outside the Service Area), you should call 911 or seek care at the nearest Emergency facility. If 911 services are not available in your area, call the local number for Emergency Medical Services.

+ Why do I need to choose a doctor, or Primary Care Physician (PCP)?

You need to choose a doctor for all your routine care. Your doctor, also called a Primary Care Physician or PCP, should be the first person you call when you have medical issues (unless it's an emergency). Your doctor will help manage your health and send you to specialty doctors or hospitals when needed.

If you don't choose a doctor, one will be assigned to you—but you can change at any time.

+ Are there certain doctors I have to choose from?

Generally, any doctor or hospital that you visit must be chosen from a list of providers who work with BMC HealthNet Plan. They are also called “in-network” providers. Your doctor will refer to you other doctors or hospitals on our approved list to make sure that your medical visit is covered by insurance (there are some exceptions). See a list of doctors and hospitals you can use.

For a complete list of the services covered by BMC HealthNet Plan, read the Covered Services List. This is the most important document you have, since it tells you what BMC HealthNet Plan will/will not cover. Your Covered Services List should have come in the mail, or you can find your plan's covered services below.

+ What is a Specialist?

There may be times when you may need to see a Specialist. A Specialist is a healthcare provider who is trained to offer specific, often more detailed, treatments than your PCP. If you think you need to see a Specialist, you should first call your PCP. Your PCP can help you identify your specialty care needs.

+ What does BMC HealthNet Plan cover?

  • Doctor visits for your routine healthcare
  • Visits with specialists (doctors who have extra training in an area of medicine)
  • Emergency room visits
  • Screenings for diabetes, allergies, heart disease, etc.
  • Extra help for special conditions like asthma and diabetes
  • Mental health and substance abuse services
  • Prescriptions
  • Money back for participating in Weight Watchers® or a qualifying health club

*There are some restrictions and certain services or doctor's visits will need prior written approval before they will be covered. For additional information see the links below.

+ Are there services I need approval for?

Some services and medications need prior approval, or prior authorization, from BMC HealthNet Plan before they will be covered. Your PCP will get this approval for you, which is why it is important that you choose a doctor that you are comfortable with who can get to know your health care needs.

+ If I get a non-covered treatment — or don't get prior approval for a treatment that requires it — will you still cover it?

If you or your PCP did not receive prior approval, BMC HealthNet Plan will not pay your doctor for your care or services. Your doctor may hold you responsible for the costs of your treatment.

+ What if I want to see a doctor who doesn't accept BMC HealthNet Plan?

In general, you must get all your healthcare services from BMC HealthNet Plan network doctors and providers. The only four exceptions are:

  • If you need emergency care (or treatment at the closest emergency room for serious illness or injury in a life-threatening situation)
  • If you need urgent care when you are traveling outside our service area
  • If you need family planning services
  • If BMC HealthNet Plan (or Beacon Health Strategies for behavioral health services) gives prior approval, also called prior authorization, for you to get care from an out-of-network provider

+ Do I need to pay for it if I see a doctor or get a service that is not covered?

If you did not receive prior approval, you will be responsible for the costs of your visit, except for the four situations listed above.

+ How do I access Behavioral Health services?

We partner with Beacon Health Strategies to manage Behavioral Health services. Call Beacon for help finding a provider for Behavioral Health services. You can also access their online provider directory here.

  • MassHealth members: 888-217-3501 toll-free, 24-hour Behavioral Health telephone line
  • ConnectorCare/Qualified Health Plan members: 877-957-5600 toll-free, 24-hour Behavioral Health telephone line

+ Is there anyone I can call for health advice?

Yes. Call the Nurse Advice Line at 800-973-6273 (MassHealth) or 866-763-4695 (ConnectorCare/Qualified Health Plan) and speak to a registered nurse when your doctor's office is closed or if you have a question about your health. All calls are confidential and you can call anytime, seven days a week.

+ What if I have complicated health needs?

Our free Care Management Program can make living with conditions like asthma, diabetes, cancer, or other special health needs easier. Pregnant members can get help through this program too. Call 866-853-5241 to see if you or your family members qualify.

+ Are my prescriptions covered?

Like services, some drugs require approval before they will be covered. For a list of drugs covered by BMC HealthNet Plan, search our drug list.

We also cover some over-the-counter drugs with a prescription from your doctor. See which ones are covered:

+ Still have questions?

Remember, you can call Member Services, Monday-Friday 8:00 a.m.- 6:00 p.m. for help with any of the items above and much more.

MassHealth members:

  • 888-566-0010 (English and other languages)
  • 888-566-0012 (Spanish)
  • 800-421-1220 (Hearing impaired – ask to be connected to the Member Services Call Center)

ConnectorCare / Qualified Health Plan members:

  • 855-833-8120 (English and other languages)
  •  866-765-0055 (TTY/TDD)