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. Pair these plans with a health savings account (or HSA). 

Simply Blue HSA PPO Plan options breakdown
Simply Blue HSA PPO
Plan options
Gold $1,450/0%1
Gold $1,300/20%1
Gold $2,7002
Silver $2,7002
Silver $3,5002
Bronze $5,5002
Bronze $6,3502
Annual deductible
(individual / family)
$1,450 / $2,900 $1,350 / $2,700 $2,700 / $5,400 $2,700 / $5,400 $3,500 / $7,000 $5,500 / $11,000 $6,350 / $12,700
Coinsurance Percentage 0% 20% 0% 20% 0% 30% 0%
Embedded
Coinsurance Maximum
N/A N/A N/A N/A N/A N/A N/A
Out-of-pocket maximum
(individual / family)
$2,450 / $4,900 $2,350 / $4,700 $5,000 / $10,000 $5,000 / $10,000 $5,500 / $11,000 $6,450 / $12,900 $6,350 / $12,700
Office visit copays
* * * * * * *
Pharmacy copays
$20 $10 $15 $15 $20 * *

*No copay. For all options, employees just pay coinsurance after they meet their deductible.

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

2 Find more details about this plan in the Simply Blue HSA with Prescription Drugs Embedded Cost-Sharing 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 HSA works

A health savings account is like a 401(k) for medical expenses. Employees own the account and use the money to pay for qualified medical expenses. Both of you can make pretax payroll contributions to an HSA.

Here are some of the benefits of a Simply Blue HSA PPO:

  • Plans that pair with a HSA typically cost less.
  • When employees have more say in how they spend their health care dollars, they may use them more responsibly.
  • No office visit copays. Employees just pay coinsurance after they meet their deductible.
  • We can make managing your account even easier with HealthEquity® HSA, our integrated support program.

Learn more about health spending accounts