PPO plans have in-network and out-of-network coverage for most services. The out-of-network annual deductible and out-of-pocket maximum are double the in-network amount. The amounts listed below apply for in-network services only. 

Simply Blue routine care ppo breakdown
Simply Blue Routine Care Plan options Silver $1,500 Silver $3,000
Annual deductible (individual / family) $1,500 / $3,000 $3,000 / $6,000
Coinsurance Percentage 30% 20%
Embedded Coinsurance Maximum N/A N/A
Out-of-pocket maximum (individual / family) $6,600 / $13,200 $6,600 / $13,200
Office visit copays $30 $30
Pharmacy copays $10 $10

Find more details about this plan in the Simply Blue Group Benefits Certificate (PDF).

Certificates are legal documents that describe the benefits of a health insurance plan. Your plan might have different benefits and limitations than those listed in this document.