BCBS PPO

The BCBS PPO Plan is a preferred provider organization that offers two levels of coverage:

  • In-network. When you receive care within the plan network, most services are covered in full, including preventive care services. You pay a copay for services such as office and emergency room visits, surgery in a physician’s office and rehabilitation therapies.
  • Out-of-network. If you receive care outside the plan network, your benefits coverage is lower; most services are covered at 80% after you meet the plan deductible, including office visits. (You pay a copay only for emergency care.) Your out-of-pocket costs are capped each year. Note that this year the University is introducing a limit on the amount of provider expenses the plan will cover, generally known as a usual, reasonable and customary (UCR) limit. Expenses over UCR are the responsibilityof the plan member and do not count toward meeting your deductible or out-of-pocket maximum.

When you join the PPO Plan, you do not need to name a primary care physician. You choose your own providers, in or outside the PPO network. Your share of the cost depends on that choice.

Change for 2014

  • Applied Behavioral Analysis (ABA) will now be covered for children between the three and six years of age who have been diagnosed with an Autism Spectrum Disorder.

Prescription drug coverage is provided through Express Scripts.

The BCBS PPO plan provides the most flexibility for you to manage your health care needs, but requires the highest premium contribution each pay period.

As a member of a BCBS health plan, you have access to Member Central, a safe and secure web site designed to help you better manage your health care needs. Be sure to log on www.bluecrossma.com/member and set up your personal account.