Your Care
Starts Here…
Choose the SCH Network for trusted care and lower costs.
We Make It Easy as 1-2-3
When it comes to choosing a medical provider or facility, it helps to see how your options work — and what it could cost you. That’s exactly what this page is designed to do. By following these steps, you can find the care that’s the best fit for your health needs and your wallet.
We Make It Easy as 1-2-3
When it comes to choosing a medical provider or facility, it helps to see how your options work — and what it could cost you. That’s exactly what this page is designed to do. By following these steps, you can find the care that’s the best fit for your health needs and your wallet.
1. Understand Your Choices Before You Receive Care
Want to save on medical costs? By choosing providers and facilities in the SCH Network, there’s no deductible to meet, and a wide range of services are available at no cost to you.
SCH Network (Tier 1)
- Pay $0 for a wide range of services when you stay in the SCH Network.
- Make sure both your provider and facility are in the SCH Network to avoid surprise costs.
BCBS BlueCard PPO Network (Tier 2)
- Higher, less predictable costs — even though it’s “in-network.”
- If care is available in the SCH Network but you choose Tier 2, you’ll pay the full deductible first, then 30% coinsurance.
Out-of-Network (Tier 3)
- After meeting your deductible, you’ll still owe 30% coinsurance.
- You may also be balance billed — meaning the provider can charge you above what your plan covers.
Watch the video to see how your choices affect your costs and find out how to make the most of your SCH Network benefits.
Note: SCMG Providers/Doctors are considered in the SCH Network (Tier 1). Affiliated Community Providers are classified as Tier 2 or Tier 3 for outpatient visits.
2. Medical Plan Comparison
Understanding the basics of each tier is the first step in making the right choice. The chart below shows a side-by-side comparison of the three tiers of coverage in the VantageBlue PPO plan, highlighting key costs like deductibles and coinsurance.
Use this chart to get a feel for how each tier handles different types of care — from routine visits to major health events. As you review, think about how you typically use your medical plan and which plan might work best for your needs and budget.
VantageBlue PPO Plan
| SCH Network | BCBS BlueCard PPO Network | Outside BCBS Network | |
|---|---|---|---|
| Tier 1 | Tier 2 | Tier 3 | |
| You Pay | |||
| Calendar Year Deductible | |||
| Individual | $0 | $1,500 | $1,500 |
| Family | $0 | $3,000 | $3,000 |
| Calendar Year Out-of-Pocket Maximum (Includes Deductible) | |||
| Individual | $4,000 | $4,000 | $8,000 |
| Family | $8,000 | $8,000 | $16,000 |
| Coinsurance / Copays | |||
| Preventive Care | $0 | $0 | $30 + 30%* |
| Personal Physician | $0 | $30 | $30 + 30%* |
| Specialist | $0 | $50 | $50 + 30%* |
| Urgent Care | $0 | $30 | $30 |
| Emergency Room | $200 | $200 | $200 |
| Diagnostic Labs | $0 | 20% or 30%* | 30%* |
| Diagnostic Imaging | $0 | 20% or 30%* | 30%* |
| Outpatient Medical Care | $0 | 20% or 30%* | 30%* |
| Outpatient Surgical Care | $0 | 20% or 30%* | 30%* |
| Hospitalization | $0 | 20% or 30%* | 30%* |
| Obstetrical Care | $0 | 20% or 30%* | 30%* |
| Physical Therapy | $0 | $0 (select locations) or 20%* | 30%* |
| Retail Rx (up to 30-day supply) | |||
| Generic | $15 | $15 | Not Covered |
| High-Cost Generic | $30 | $30 | |
| Brand Preferred | $50 | $50 | |
| Brand Non-Preferred | $80 | $80 | |
| Specialty Preferred | $125 | $125 | |
| Specialty Non-Preferred | $250 | $250 | |
* After deductible. For certain Tier 2 services that SCH can provide, you will be subject to 30% coinsurance if you opt to receive services from a provider or facility outside the SCH Network
See How the Plans Work in Real Life
It can be hard to picture how a health plan actually works until you use it — so we’ve put together a few examples. Each one highlights unique health care needs that can all be handled fully in the SCH Network, resulting in no cost to the employee in many cases. For each example, you’ll see how much care each person needed, what the SCH Network covered, and what they paid out of pocket. Click below to meet these individuals — it’s a helpful way to see how your own costs could add up under each plan.
Note: The examples provided are for illustrative purposes only. Individual expenses may vary based on your providers and services received.
Meet Sarah, PCT: Orthopedic Patient
See how Sarah navigated her care using the SCH Network, saving money and avoiding any surprise bills.
Health Snapshot
Sarah is a 49-year-old patient care tech. She elected individual coverage under the VantageBlue PPO plan during Open Enrollment. A few months later, she started experiencing knee pain that made it hard to stay on her feet during long shifts. Sarah scheduled a visit with her primary care provider at South County Health, who recommended she see an orthopedic specialist.
Sarah's Care Journey
After confirming that the provider performed surgery at South County Hospital, Sarah chose a specialist from Ortho Rhode Island.The specialist ordered an X-ray and determined she needed outpatient knee surgery followed by physical therapy. Sarah paid a one-time $50 fee for the initial consultation. Sarah confirmed that the procedure and all follow-up care would take place within South County Health.
A Win for Sarah and South County Health
Because Sarah kept her care in the SCH Network, her only out-of-pocket cost was a $50 copay for the specialist visit to Ortho Rhode Island. Because she kept all other services in the SCH Network — including imaging, surgery, and rehab — she paid nothing else out of pocket. If she had used a Tier 2 or 3 provider or had surgery at Ortho RI’s Ambulatory Surgical Center, she would have faced a $1,500 deductible and 30% coinsurance — significantly increasing her cost for services she could access through South County Health.
By planning ahead and choosing South County Health, Sarah saved money, received high-quality care close to home, and supported a provider network that knows her — while helping SCH control costs and deliver exceptional care to the community.
“By staying in the SCH Network, I paid only $50 out of pocket.”
— Sarah C, SCH Patient
| VANTAGE BLUE PPO COST BREAKDOWN | |||
| Service | SCH Network Tier 1 |
BCBS BlueCard PPO Network Tier 2 |
Outside BCBS Network Tier 3 |
| Care Location for X-rays and Surgery | South County Hospital | Ortho RI Surgical Center | Location not in SCH Network or BCBS BlueCard PPO Network |
| Deductible (Individual) | $0 | $1,500 | $1,500 |
| Out-of-Pocket Maximum (Individual) | $4,000 | $4,000 | $8,000 |
| Primary Care Provider Visit | $0 | $30 | $150 |
| Specialist Visit | $50* | $50* | $275 |
| X-ray | $0 | $200 | $250 |
| Outpatient Knee Surgery | $0 | $1,800 | $2,747 |
| Physical Therapy (10 visits) | $0 | $600 | $660 |
| What Sarah Paid | $50* | $2,680 | $4,082 |
Meet Emily, RT: Obstetrics Patient
See how Emily planned ahead to keep all of her maternity care within the SCH Network.
Health Snapshot
Emily is a 33-year-old respiratory therapist. She elected the VantageBlue PPO plan with individual coverage during Open Enrollment. A few months later, she learned she was pregnant with her first child.
Emily's Care Journey
Emily began by scheduling a visit directly with the Center for Women’s Health at South County Health, where her pregnancy was confirmed. She then selected an OB/GYN within the SCH Network and made sure all of her care — including lab work, ultrasounds, and delivery — would take place with SCH-affiliated providers and facilities.
Over the next several months, Emily enjoyed a healthy pregnancy. She had routine prenatal visits and testing, all covered in full because she stayed in the SCH Network. When it was time to deliver, Emily gave birth at South County Hospital and remained for two nights to recover.
Because she planned ahead and chose SCH Network providers and facilites at every step, Emily received high-quality maternity care — from her first checkup to delivery — with no surprise costs.
A Win for Emily and South County Health
Emily made sure her entire pregnancy journey — from her first prenatal visit to delivery — stayed within the SCH Network. As a result, she paid nothing out of pocket.
Had she chosen providers outside the SCH Network, or given birth at another hospital such as Women & Infants, she would have faced a $1,500 deductible and 30% coinsurance for services that South County Health can provide — and would have reached her $4,000 out-of-pocket maximum under Tier 2.
By choosing to stay in the SCH Network, Emily saved money, stayed close to home, and received care from a team that knows her best — which also supports South County Health’s ability to offer great care while keeping health care affordable for everyone.
“By choosing SCH Network providers and facilities for all my maternity care, I didn’t have to worry about surprise bills — everything was covered.”
— Emily J,SCH Patient
| VANTAGE BLUE PPO COST BREAKDOWN | |||
| Service | SCH Network Tier 1 |
BCBS BlueCard PPO Network Tier 2 |
Outside BCBS Network Tier 3 |
| Care Location for Labs, Ultrasounds, and Delivery |
South County Hospital | Women & Infants | Location not in SCH Network or BCBS BlueCard PPO Network |
| Deductible (Individual) | $0 | $1,500 | $1,500 |
| Out-of-Pocket Maximum (Individual) | $4,000 | $4,000 | $8,000 |
| Primary Care Provider Visit | $0 | $30 | $150 |
| OB/GYN Visits (10) | $0 | $500 | $700 |
| Diagnostic Lab Services | $0 | $580 | $750 |
| Ultrasound Imaging (2) | $0 | $520 | $900 |
| Inpatient Delivery & 2-Night Hospital Stay | $0 | $2,610 | $4,500 |
| What Emily Paid | $0 | $4,000 | $6,940 |
Meet Lisa, RN: Cancer Patient
See how Lisa managed her cancer diagnosis and treatment through the SCH Network without the financial strain.
Health Snapshot
Lisa is a 58-year-old registered nurse. She elected individual coverage under the VantageBlue PPO plan during Open Enrollment. After experiencing persistent fatigue and abdominal discomfort, Lisa scheduled a visit with her primary care provider with South County Health.
Lisa's Care Journey
After experiencing symptoms, Lisa visited her primary care provider, who ordered lab work, imaging, and referred her to an oncologist at South County Health Cancer Center — all within the SCH Network. Following additional tests, she was diagnosed with early-stage colon cancer.
From diagnosis through treatment, Lisa chose to stay at South County Health. Her care included specialist visits, diagnostic testing, a short inpatient stay, and several months of chemotherapy — all delivered through SCH Network providers and facilities. If she had required surgery or radiation therapy, choosing South County Hospital and South County Health Radiation Therapy would also have resulted in no out-of-pocket expense.
A Win for Lisa — and South County Health
Because Lisa stayed in the SCH Network at every step, she paid nothing out of pocket. If she had gone outside the SCH Network — for example, to Dana-Farber — she would have faced a $1,500 deductible, 30% coinsurance, and significantly higher total costs.
By choosing South County Health, Lisa received high-quality, coordinated care close to home while avoiding financial stress — and supported SCH’s commitment to affordable, community-based care.
“I was able to get all the care I needed — including chemotherapy — close to home and without the financial burden. Staying in the SCH Network made all the difference.”
—Lisa H, SCH Patient
| VANTAGE BLUE PPO COST BREAKDOWN | |||
| Service | SCH Network Tier 1 |
BCBS BlueCard PPO Network Tier 2 |
Outside BCBS Network Tier 3 |
| Care Location for Labs, Imaging, Hospitalization, and Chemotherapy |
South County Hospital | Dana Farber | Location not in SCH Network or BCBS BlueCard PPO Network |
| Deductible (Individual) | $0 | $1,500 | $1,500 |
| Out-of-Pocket Maximum (Individual) | $4,000 | $4,000 | $8,000 |
| Primary Care Provider Visit | $0 | $30 | $150 |
| Specialist Visits (3) | $0 | $150 | $825 |
| Diagnostic Lab | $0 | $580 | $750 |
| Ultrasound Imaging (2) | $0 | $1,100 | $1,650 |
| Chemotherapy | $0 | $2,400 | $3,600 |
| Inpatient Hospital Stay | $0 | $2,400 | $3,600 |
| What Lisa Paid | $0 | $4,000 | $8,000 |
3. Compare Your Costs Before Choosing Where You Receive Care
Choosing the right care can be tricky, but this interactive tool makes the process simple. To estimate your health care costs and compare what you’ll pay, you’ll need to enter a few details based on your expected health care use. This interactive calculator helps you estimate your potential health care spending under the SCH Network, BCBS BlueCard PPO Network, or outside of the BCBS network. Just enter how many times you expect to use each type of service, and see your out-of-pocket costs update instantly.
How to Use This Tool:
Estimate your yearly usage for each service listed.
Think about how many times you visit your primary care doctor, specialists, urgent care, or use prescription drugs. Remember: Preventive care typically costs nothing in-network.
Enter the numbers in the “Usage” column.
The calculator automatically updates costs based on your estimates, showing how much you could save by getting care in the SCH Network instead of the BCBS BlueCard PPO Network or out-of-network providers.
Note: SCMG Providers/Doctors are considered in the SCH Network (Tier 1). Affiliated Community Providers are classified as Tier 2 or Tier 3 for outpatient visits.
| Service | Usage | SCH Network Tier 1 |
BlueCard PPO Tier 2 |
Out-of-Network Tier 3 |
|---|---|---|---|---|
| Preventive Care | $0 | $0 | $0 | |
| Primary Care | $0 | $0 | $0 | |
| Specialist | $0 | $0 | $0 | |
| Urgent Care | $0 | $0 | $0 | |
| YOU PAY (Estimate Based on National Average Costs) | ||||
| Diagnostic Imaging (e.g., MRI, CT) | $0 | $0 | $0 | |
| Labs & Bloodwork | $0 | $0 | $0 | |
| Outpatient Surgery | $0 | $0 | $0 | |
| Hospitalization (Inpatient) | $0 | $0 | $0 | |
| Outpatient Medical Visit | $0 | $0 | $0 | |
| Retail Rx (30-day) | ||||
| Generic | $0 | $0 | $0 | |
| High-Cost Generic | $0 | $0 | $0 | |
| Brand Preferred | $0 | $0 | $0 | |
| Brand Non-Preferred | $0 | $0 | $0 | |
| Specialty Preferred | $0 | $0 | $0 | |
| Specialty Non-Preferred | $0 | $0 | $0 | |
| WHAT YOU PAY | $0 | $0 | $0 | |