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BlueCross/BlueShield PPO Plan

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.

For detailed information on how the PPO plan works and what services are covered, contact Blue Cross BlueShield of Tennessee.

In-Network Benefits
To receive maximum plan benefits, you should choose a provider who participates 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.

Physician Visits
For office visits to primary care physicians, your copay is $20 per visit — both in and out of the network and $30 for specialist office visits. After your copayment, office visits are covered at 80% in-network and at 60% of approved charges outside the network.

Prescription Drug Coverage
Prescription drug coverage for the PPO Plan is provided by BlueCross BlueShield and is available through most retail pharmacies or home delivery.

• One card for BCBS, which you will need when you receive medical care, and
• One card for WHI  which you will need when you purchase prescriptions at the pharmacy.

The WHI retail pharmacy network consists of more than 54,000 participating chain and independent pharmacies nationwide.
 
Out-of-Network Benefits
If you receive care from a provider outside of Blue Network P, you will still receive benefits, but at a lower level.