PPO Plans

PPO stands for Preferred Provider Organization. A PPO’s premiums are usually much higher than an HDHP, but that comes with greater flexibility. PPOs allow you to get both in-network and out-of-network care — though out-of-network providers cost more. You can also see a specialist without a referral. The plans also include an out-of-pocket maximum for in-network care. If you reach your out-of-pocket maximum, your insurer covers all costs.

2024 Plan Offerings

The values below are for in-network benefits for the 2024 plan year.

Plan Name (Click for Highlights)	Annual Deductible (Individual / Family)	Out-of-Pocket Maximum Individual / Family (Includes all copays, deductibles, & coins)	Office Visit Primary & Telemedicine	Office Visit Specialist	Hospital - Inpatient/Outpatient (Includes Maternity, Mental Health, & Substance Abuse	Mental Health & Substance Abuse Outpatient Services & Office Visit	Urgent Care/ER	Prescription Drug
PPO 1000-70	$1,000/$3,000	$3,500/$7,000	$35	$70	70% after deductible	100%	$75/$750	$10/$25/$40/$80/25% (max $100)
PPO 2000-80	$2,000/$6,000	$7,150/$14,300	$35	$70	80% after deductible	100%	$75/$500	$10/$25/$40/$80/25% (max $100)
PPO 1500-70	$1,500/$4,500	$5,000/$10,000	$35	$70	70% after deductible	100%	$75/$750	$10/$25/$40/$80/25% (max $100)
PPO 2500-80	$2,500/$7,500	$7,150/$14,300	$35	$70	80% after deductible	100%	$75/$500	$10/$25/$40/$80/25% (max $100)
PPO 2500-70	$2,500/$7,500	$8,150/$16,300	$35	$70	70% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 3500-80	$3,500/$10,500	$8,150/$16,300	$35	$70	80% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 3500-70	$3,500/$7,000	$8,150/$16,300	$35	$70	70% after deductible	100%	$100/$1,000	$20/$35/$45/$90/25% (max $100)
PPO 5000-60	$5,000/$10,000	$8,150/$16,300	$35	$70	60% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 2500-60	$2,500/$5,000	$8,150/$16,300	$45	60% after deductible	60% after deductible	100%	$135/60% after deductible	$10/50% (max $100)
PPO 3500-60	$3,500/$7,000	$8,150/$16,300	$45	60% after deductible	60% after deductible	100%	$135/60% after deductible	$10/50% (max $100)
PPO 4000-70	$4,000/$8,000	$8,550/$17,100	$50	$100	70% after deductible	100%	$100/$1,000	$15/$35/$45/$90/25% (min $50 / max $200)
PPO 5000-70	$5,000/$10,000	$8,550/$17,100	$40	$120	70% after deductible	100%	$120/$1,000	$15/$35/$45/$90/25% (min $50 / max $200)
PPO 7900-100	$7,900/$15,800	$7,900/$15,800	100% after deductible	100% after deductible	100% after deductible	100% after deductible	100% after deductible	$20/$35/$45/$90/25% (max $200)
PPO 8550-100	$8,550/$17,100	$8,550/$17,100	100% after deductible	100% after deductible	100% after deductible	100% after deductible	100% after deductible	$20/$35/$45/$90/25% (max $200)

2023 Plan Offerings

The values below are for in-network benefits for the 2023 plan year.

Plan Name (Click for Highlights)	Annual Deductible (Individual / Family)	Out-of-Pocket Maximum Individual / Family (Includes all copays, deductibles, & coins)	Office Visit Primary & Telemedicine	Office Visit Specialist	Hospital - Inpatient/Outpatient (Includes Maternity, Mental Health, & Substance Abuse	Mental Health & Substance Abuse Outpatient Services & Office Visit	Urgent Care/ER	Prescription Drug
PPO 1000-70	$1,000/$3,000	$3,500/$7,000	$35	$70	70% after deductible	100%	$75/$750	$10/$25/$40/$80/25% (max $100)
PPO 2000-80	$2,000/$6,000	$7,150/$14,300	$35	$70	80% after deductible	100%	$75/$500	$10/$25/$40/$80/25% (max $100)
PPO 1500-70	$1,500/$4,500	$5,000/$10,000	$35	$70	70% after deductible	100%	$75/$750	$10/$25/$40/$80/25% (max $100)
PPO 2500-80	$2,500/$7,500	$7,150/$14,300	$35	$70	80% after deductible	100%	$75/$500	$10/$25/$40/$80/25% (max $100)
PPO 2000-70	$2,000/$6,000	$8,150/$16,300	$35	$70	70% after deductible	100%	$75/$750	$10/$25/$40/$80/25% (max $100)
PPO 2500-70	$2,500/$7,500	$8,150/$16,300	$35	$70	70% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 3500-80	$3,500/$10,500	$8,150/$16,300	$35	$70	80% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 3500-70	$3,500/$7,000	$8,150/$16,300	$35	$70	70% after deductible	100%	$100/$1,000	$20/$35/$45/$90/25% (max $100)
PPO 5000-60	$5,000/$10,000	$8,150/$16,300	$35	$70	60% after deductible	100%	$100/$1,000	$10/$25/$40/$80/25% (max $100)
PPO 2500-60	$2,500/$5,000	$8,150/$16,300	$45	60% after deductible	60% after deductible	100%	$135/60% after deductible	$10/50% (max $100)
PPO 3500-60	$3,500/$7,000	$8,150/$16,300	$45	60% after deductible	60% after deductible	100%	$135/60% after deductible	$10/50% (max $100)
PPO 4000-70	$4,000/$8,000	$8,550/$17,100	$50	60% after deductible	70% after deductible	100%	$100/$1,000	$15/$35/$45/$90/25% (min $50 / max $200)
PPO 5000-70	$5,000/$10,000	$8,550/$17,100	$40	70% after deductible	70% after deductible	100%	$120/$1,000	$15/$35/$45/$90/25% (min $50 / max $200)
PPO 6000-60	$6,000/$12,000	$8,550/$17,100	$95	70% after deductible	60% after deductible	100%	$190/$1,500	$400 rx deductible then $15/$35/$45/$90/25% (min $50 / max $200)
PPO 7900-100	$7,900/$15,800	$7,900/$15,800	100% after deductible	100% after deductible	100% after deductible	100% after deductible	100% after deductible	$20/$35/$45/$90/25% (max $200)

Additional Notes

The office visit primary copay is waived for the first 3 visits* if a PCP is selected on Blue Connect. Office Visit Primary and Specialist visits copays include office surgery, consultation, x-rays & labs. (*Does not apply to the PPO 7900-100).

For more information on assigning a PCP in Blue Connect click here.

Vision

All Plans have coverage for a routine eye exam covered at 100% through an in-network provider. This is an incorporated benefit with PPO Health Plan coverage, lenses and frames are covered 100% up to $130, then 10%. This is not full “vision coverage” and requires a claim to be submitted for reimbursement.

Telemedicine

Telemedicine services are provided through Teledoc. Click here for more information on Teledoc Telehealth coverage.

Pharmacy/Rx

All Plans offer the same prescription formulary, referred to as Essential C Formulary. For more information around Pharmacy benefit coverage click here.

PPO Plans have a drug co-payment, as shown above. Up to a 30-day supply is one drug copayment, and a 31-60 day supply is two drug copayments. A 61-90 day supply is three drug copayments at retail pharmacies or two and a half drug copayments using mail-order service.

All plans offer mail order subscription programs through Amazon MedsYourWay. Click here for more information.