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 ppo breakdown
Simply Blue Routine Care Plan options Silver $2,500 Bronze $7,900
Annual deductible (individual / family) $2,500 / $5,000 $7,900 / $15,800
Coinsurance Percentage 30% 0%
Embedded Coinsurance Maximum N/A N/A
Out-of-pocket maximum (individual / family) $8,200 / $15,800 $7,900 / $15,800
PCP office visit copays $30 $30
Preferred generic pharmacy copays $10 $10

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.