The PPO Plan --- Blue Cross Blue Shield
As a member of the BCBS PPO, you have great flexibility to choose your physician or other health care provider. Each time you need care you may choose to receive services from a:
- PPO provider (in the Blue Network P)
- Non-PPO provider (outside of the Blue Network P)
The Blue Network P is a group of health care professionals that have agreed to special pricing arrangements for BCBS plan participants. Blue Network P providers also agree to follow guidelines that, where medically appropriate, encourage the use of alternatives to costly hospitalization.
| Key Features of BCBS Out-of-Network Services | |
|---|---|
| Annual Deductible | None |
| Coverage level (for most services) | 80% after $10 copay |
| Annual out-of-pocket maximum | $1,000 single; $2,000 family |
| Maximum lifetime benefit | None |
| Claim filing | None |
Physician Visits:
For office visits physicians, your copay is $10 per visit – both in and out of the network. After your Copayment, office visits are covered at 80% in-network and 605 of approved charges outside the network.
Pharmacy Home Delivery:
You can have prescription drugs (up to a 102-day supply for most drugs) delivered to your home through your BCBS plan. For details, visit the Pharmacy section of the BCBS website at www.bcbst.com or call (800) 367-7790
In-Network Benefits:
To receive maximum plan benefits, you should choose a provider who participants in the Blue Network P. Although in-network providers are listed in the directory published by the plan, it is important that you call the provider before you receive care and verify that he/she participates in Blue Network P.
Out-of-Network Benefits:
If receive care from a provider outside of Blue Network P, you will still receive benefits, but at a lower level.
| Key Features of BCBS Out-of-Network Services | |
|---|---|
| Annual Deductible | $200 individual; $600 family |
| Coverage level (for most services) | 60% of approved charges after $10 copay |
| Annual out-of-pocket maximum | $5,000 single; $10,000 family |
| Maximum lifetime benefit | $1 million |
| Claim filing | You may be required to pay the entire bill up front and file for reimbursement. |