Healthy Blue AchieveSM PPO

When your employees take an active role in improving their health, everyone wins.

Plan highlights
  • This wellness-based plan rewards employees who commit to a healthier lifestyle.
  • Prescription drug coverage is included. 
  • Preventive care is 100% covered.

NETWORK SIZE

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PREMIUM COST

$

LEVEL OF CONSUMER ENGAGEMENT

MEDIUM

INDIVIDUAL DEDUCTIBLE

$250 - $2,500

HOW WELLNESS PLANS WORK

Our PPO wellness plan for Employers can save you 8 -12% on premiums.  And your employees will save too, when they meet or work toward certain health targets. This plan type can motivate your employees to be healthy with two benefit levels: enhanced and standard. 

  • The enhanced level has lower out-of-pocket costs with lower copays, deductibles and coinsurance.

  • The standard level has higher out-of-pocket costs.

To qualify for enhanced, your employees need to meet key health metrics. If they don't, they can still qualify with the help of these free support programs:

  • WW®, formerly Weight Watchers

  • Steps walking program, powered by WebMD®

  • Tobacco Cessation Coaching, powered by WebMD

These features can help your employees keep their weight, diabetes, blood pressure and other health issues in check. In turn, this can translate to lower costs and a healthier workplace overall.

 

Want more details about Healthy Blue Achieve PPO?

Plan options for 2020

Platinum $250 / $1,250

This is a top-level plan with either a $250 or $1,250 deductible.

Monthly premium

High

Deductible

$250

Out-of-pocket maximum

$6,600

PCP office visit copay

$20

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

In network 

Enhanced / Standard

$250 / $1,250

Out of network 

Enhanced / Standard

$500 / $2,500

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

In network 

Enhanced / Standard

$500 / $2,500

Out of network 

Enhanced / Standard

$1,000 / $5,000

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

In network 

Enhanced / Standard

20% / 30%

Out of network 

Enhanced / Standard

40% / 50%

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network 

Enhanced / Standard

$500 / $1,500

Out of network 

Enhanced / Standard

$1,000 / $3,000

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network 

Enhanced / Standard

$1,000 / $3,000

Out of network 

Enhanced / Standard

$2,000 / $6,000

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network 

Enhanced / Standard

$6,600 / $6,600

Out of network 

Enhanced / Standard

$13,200 / $13,200

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

In network 

Enhanced / Standard

$20 / $30

Out of network 

Enhanced / Standard

40% after deductible / 50% after deductible

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

In network 

Enhanced / Standard

$10 / $20

Out of network 

Enhanced / Standard

$10 plus 25% approved amount / $20 plus 25% approved amount

Individual annual deductible

An individual annual deductible is the amount you pay each year for health services before your health insurance begins to pay. 

$250 / $1,250 $500 / $2,500

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

$500 / $2,500 $1,000 / $5,000

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

20% / 30% 40% / 50%

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

$500 / $1,500 $1,000 / $3,000

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

$1,000 / $3,000 $2,000 / $6,000

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

$6,600 / $6,600 $13,200 / $13,200

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

$20 / $30 40% after deductible / 50% after deductible

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

$10 / $20 $10 plus 25% approved amount / $20 plus 25% approved amount

Gold $1,000 / $2,500

This is a mid-level plan with either a $1,000 or $2,500 deductible.

Monthly premium

Medium

Deductible

$1,000

Out-of-pocket maximum

$8,150

PCP office visit copay

$30

In network 

Enhanced / Standard

$1,000 / $2,500

Out of network 

Enhanced / Standard

$2,000 / $5,000

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

In network 

Enhanced / Standard

$2,000 / $5,000

Out of network 

Enhanced / Standard

$4,000 / $10,000

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

In network 

Enhanced / Standard

20% / 40%

Out of network 

Enhanced / Standard

40% / 60%

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network 

Enhanced / Standard

$4,000 / N/A

Out of network 

Enhanced / Standard

$8,000 / N/A

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

In network 

Enhanced / Standard

$8,000 / N/A

Out of network 

Enhanced / Standard

$16,000 / N/A

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

In network 

Enhanced / Standard

$8,150 / $8,150

Out of network 

Enhanced / Standard

$16,300 / $16,300

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

In network 

Enhanced / Standard

$30 / $50

Out of network 

Enhanced / Standard

40% after deductible / 60% after deductible

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

In network 

Enhanced / Standard

$20 / $30

Out of network 

Enhanced / Standard

$20 plus 25% approved amount / $30 plus 25% approved amount

$1,000 / $2,500 $2,000 / $5,000

Family annual deductible

A family annual deductible is the amount you and others on your plan have to pay each year for health services before your health insurance begins to pay. 

$2,000 / $5,000 $4,000 / $10,000

Coinsurance percentage

Coinsurance is your share of the cost of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance once you’ve met your plan’s deductible.

20% / 40% 40% / 60%

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

$4,000 / N/A $8,000 / N/A

Embedded coinsurance maximum

The embedded coinsurance maximum is the most you’ll have to pay in coinsurance during a policy period. It makes up part of the out-of-pocket maximum.

$8,000 / N/A $16,000 / N/A

Out-of-pocket maximum

This represents the most you’ll have to pay during a policy period, usually a year, for health care services. Once you've reached it, your plan pays 100% of the allowed amount for covered services.

$8,150 / $8,150 $16,300 / $16,300

PCP office visit copay

This is what you'll pay when you see your primary care physician, the doctor you've selected to oversee your health care.

$30 / $50 40% after deductible / 60% after deductible

Preferred generic pharmacy copay

This is what you'll pay when you buy a commonly prescribed generic version of a brand-name drug. This is the lowest copay tier for prescription drugs.

$20 / $30 $20 plus 25% approved amount / $30 plus 25% approved amount
THE BLUE CROSS DIFFERENCE

See how Smarter, Better Healthcare℠ tackles your small business challenges

Network access and solutions

Choices for care

Helping your employees avoid costly ER visits and get the care they need quickly and conveniently.

Value-based care

Elevating the quality of care by rewarding physicians for better patient health outcomes.

Improved care for healthy employees

Coordinated Care

A care management support program for your employees and their family members who face complex issues.

Health & Well-Being

Encourage a culture of well-being with tools and resources to help your employees improve their whole health.

Personalized member engagement

Online member account

Your employees will get the tools, information and support they need all under one secure online account.

Blue Cross Rewards

Incentivizing employees to use cost-effective providers by using our “Find Care” tools.

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