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. You can pair these plans with an employer-sponsored health reimbursement arrangement (or HRA). 

Simply Blue HRA PPO Plan options breakdown
Simply Blue HRA PPO
Plan options
Platinum $5,000 Gold $1,500 Gold $2,000 Gold $4,000
Annual deductible
(individual / family)
$5,000 / $10,000 $1,500 / $3,000 $2,000 / $4,000 $4,000 / $8,000
Coinsurance Percentage 30% 20% 20% 20%
Coinsurance Maximum

(individual / family)
N/A $3,500 / $7,000 N/A N/A
Out-of-pocket maximum
(individual / family)
$6,350 / $12,700 $6,350 / $12,700 $6,350 / $12,700 $6,350 / $12,700
PCP office visit copays
$30 $30 $30 $30
Preferred generic pharmacy copays
$15 $15 $20 $20

Find more details about this plan in the Simply Blue HRA 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.

How an HRA works

HRA stands for health reimbursement arrangement. You set aside a defined amount of money in the HRA for each employee. Employees are then reimbursed for medical expenses not covered by their health insurance plan, like deductibles and coinsurance. Here are the benefits of a Simply Blue HRA PPO:

  • Plans that pair with an HRA typically cost less.
  • When employees have more say in how they spend their health care dollars, they may use them more responsibly.
  • You can deduct HRA reimbursements from your taxes.
  • You own the account and keep unused funds at the end of the year.
  • We can make managing your account even easier with our HealthEquity® HRA, our integrated support program.

Want to learn more about health spending accounts?