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 Plan options||Silver $1,500||Silver $3,000|
|Annual deductible (individual / family)||$1,500 / $3,000||$3,000 / $6,000|
|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|
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.