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

Healthy Blue Achieve PPO Plan options breakdown
Healthy Blue Achieve PPO
Plan options
Platinum $250
Enhanced level*
Standard level
Gold $1,000
Enhanced level
Standard level
Annual deductible
(individual / family)
$250 / $500
$1,250 / $2,500
$1,000 / $2,000
$2,000 / $5,000
Coinsurance Percentage 20%
30%
20%
40%
Embedded
Coinsurance Maximum

(individual / family)
$500 / $1,000
$1,500/$3,000
$4,000 / $8,000
N/A
Out-of-pocket maximum
$6,600 / $13,200
$8,150 / $16,300
PCP office visit copays
$20
$30
$20
$40
Preferred generic pharmacy copays
$10
$20
$15
$20

*Enhanced versus standard level: Members who meet or work toward the plan's health measures are eligible for the enhanced level. Those who don't receive the standard level. See the "How it works" tab for more details.

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