Blue Cross® Physician Choice PPO

Who is this for?

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If you're a Blue Cross Physician Choice PPO member or if you're thinking of choosing this coverage, this information can help you learn how to use your plan.

Our Physician Choice PPO plan is unique. You'll save more money if you see doctors in a level 1 Organized System of Care, or OSC. You can also see any doctor in our PPO network, and even out-of-network doctors.

If you choose to select a primary care doctor in a level 1 OSC and have them coordinate your care, you'll the save the most on your out-of-pocket costs. Compared to level 2 or out-of-network cost shares, you could save at least 50 percent.

This is a group plan. You're eligible for this plan if your employer offers it to you and if you live in one of these 46 counties.

What's an Organized System of Care?

An OSC is a community of doctors and hospitals within our PPO network. They've met our standards that allow them to work together to provide high quality care at lower costs.

This plan divides the OSCs into two levels. If you select a primary care doctor in a level 1 OSC and visit providers in that OSC, you'll have lower copays and deductibles. We call this level 1 cost share.


How do cost share levels work?

This plan has three levels of cost share: level 1, level 2 and out-of-network. The cost share level could be different for each member on your plan.
Select a cost share level to see how it works.

How do the deductibles work?

This plan has three deductibles. Two of them are in-network deductibles: level 1 and level 2. The other is the out-of-network deductible.

Any time you get care that falls within level 1 cost share, it counts only toward your level 1 deductible.

Anything you pay toward your level 2 deductible also goes toward your level 1 deductible. So, if you get care that qualifies as level 2 cost share and you have to pay $500 toward your level 2 deductible, that $500 also goes toward level 1.

If you get health care services that qualify as out-of-network cost share, not only will they go toward your out-of-network deductible, they'll also go toward your level 1 and level 2 deductibles.

What else should I know?

  • Exemptions: If you have dependents, like children or a spouse, who live outside the 46 covered counties, ask your employer to let us know. They'll get level 1 cost share for services from any Blue Cross PPO provider in the country.