10/10/2024 12:00:00 PM
Every person covered by the plan chooses a primary care clinic (PCC). This clinic is the hub for the care you need. The cost level of your PCC determines in part how much you will pay for care.
To get care elsewhere, you usually need a referral from your PCC. That referral means your visit is covered at the same copay as your PCC. If you don’t get a referral, you pay the entire medical bill yourself. There is often no coverage if you get care without a referral unless it’s emergency or urgent care. Learn more.
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PCC cost levels can change each year. The cost level can be different for HealthPartners than it is for Blue Cross. Find your clinic's 2025 cost level.
Clinic cost levels determine in part how much you pay when you get care. Depending on the PCC you choose, your copay when you see a doctor may be $35. It could also be $40, $70, or $90. Your PCC’s cost level also caps the most you’ll have to pay for care under the plan in a year. For example, if you’re covering just yourself in 2025, your out-of-pocket maximum may be as low as $1,700 or as high as $3,600. The amount you pay for copays, coinsurance, annual deductibles, and overall yearly cost to you depends on the cost level of the PCC you choose.
You can compare the differences across cost levels 1, 2, 3, and 4 in the Schedule of Benefits.
Family coverage, PCCs, and cost levels
You and your family members may choose different PCCs within the same health plan administrator. The PCCs can even be at different cost levels. The family member whose clinic cost level is the highest sets your family’s deductible and out-of-pocket maximum. Review the 2024 Summary of Benefits for details.
Open Enrollment for 2024