2-50 employees

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Health Plans

Blue Cross® Physician Choice PPO

This plan includes choices for access and cost sharing with our innovative Organized Systems of Care program. It offers up to 9% in savings for employers compared with similar Simply Blue plans.

Plan highlights
  • Employees get access to our entire PPO network as well as out-of-network doctors and hospitals.
  • Prescription drug coverage is included. 
  • Preventive care is 100% covered.

NETWORK SIZE

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PREMIUM COST

$$$

LEVEL OF CONSUMER ENGAGEMENT

High

INDIVIDUAL DEDUCTIBLE

$1,000 - $5,500

HOW COST SHARING WORKS

The Physician Choice PPO uses Organized Systems of Care, or OSCs. These are communities of doctors and hospitals within our PPO network. They meet certain standards that allow them to provide coordinated, high quality care and lower costs. These plans are available to employers in 64 counties.

If your employees go to a doctor or hospital in a Level 1 OSC, they'll pay the lowest cost share. They can search for a Level 1 OSC primary care doctor using Find a Doctor. Learn more about OSCs in this video.

Read our blog or watch our video to learn more about how this plan works. You can also learn more about this plan in our FAQ section.

 

Level 1 cost share (lower costs)

OSC

$

Use doctors and hospitals in your OSC for the lowest costs

For the lowest out-of-pocket costs, your employee would first choose a primary care doctor in a Level 1 OSC. Then the employee could use doctors and hospitals in that same Level 1 OSC or get a referral from their primary care doctor to choose providers in the PPO network outside their OSC.

Level 2 cost share (higher costs)

PPO network

$$

Use doctors and hospitals in the PPO network, but not in a Level 1 OSC, for higher costs

Your employees can access more provider choices with Level 2 cost sharing, in which your employee can:

  •  Choose a primary care doctor from the PPO network who is not in a Level 1 OSC
  • Choose to not name a primary care doctor at all
  • Or choose a primary care doctor in a Level 1 OSC, but have access to providers outside that OSC without a referral

Out-of-network (highest costs)

Out of our PPO network

$$$

Use any doctor and hospital for the highest costs

Physician Choice PPO gives your employees access to doctors and hospitals not contracted with Blue Cross, but the employee will bear the highest out-of-pocket costs for providers out of our PPO network. When paying out-of-network costs, referrals for Level 1 cost share are not required outside the PPO network. 

Plan options

Gold $1,000

This is a mid-level plan with a $1,000 deductible.

Monthly premium

Medium

Deductible

$1,000

Out-of-pocket maximum

$6,600

PCP office visit copay

$20

Individual annual deductible

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 1

$1,000

In network 2

$2,500

Out of network

$5,000

Family annual deductible

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 1

$2,000

In network 2

$5,000

Out of network

$10,000

Coinsurance percentage

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 1

20%

In network 2

20%

Out of network

50%

Individual embedded coinsurance maximum

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 1

$2,000

In network 2

N/A

Out of network

N/A

Family embedded coinsurance maximum

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 1

$4,000

In network 2

N/A

Out of network

N/A

Individual out-of-pocket maximum

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 1

$6,600

In network 2

$6,600

Out of network

$13,200

Family out-of-pocket maximum

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 1

$13,200

In network 2

$13,200

Out of network

$26,400

PCP office visit copay

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 1

$20

In network 2

$40

Out of network

50% after deductible

Preferred generic pharmacy copay

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 1

$20

In network 2

$20

Out of network

$15 plus 25% approved cost

Individual annual deductible

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

 $1,000 $2,500 $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 $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% 20% 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.

 $2,000 N/A 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.

 $4,000 N/A 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.

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

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.

 $13,200 $13,200 $26,400

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 $40 50% 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 $20 $15 plus 25% approved cost

Silver $4,000

This is a standard-level plan with a $4,000 deductible.

Monthly premium

Medium

Deductible

$4,000

Out-of-pocket maximum

$8,150

PCP office visit copay

$40

Individual annual deductible

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 1

$4,000

In network 2

$5,500

Out of network

$11,000

Family annual deductible

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 1

$8,000

In network 2

$11,000

Out of network

$22,000

Coinsurance percentage

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 1

30%

In network 2

40%

Out of network

50%

Individual embedded coinsurance maximum

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 1

N/A

In network 2

N/A

Out of network

N/A

Family embedded coinsurance maximum

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 1

N/A

In network 2

N/A

Out of network

N/A

Individual out-of-pocket maximum

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 1

$8,150

In network 2

$8,150

Out of network

$16,300

Family out-of-pocket maximum

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 1

$16,300

In network 2

$16,300

Out of network

$32,600

PCP office visit copay

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 1

$40

In network 2

$50

Out of network

50% after deductible

Preferred generic pharmacy copay

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 1

$30

In network 2

$30

Out of network

$30 plus 25% of approved cost

Individual annual deductible

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

 $4,000 $5,500 $11,000

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. 

 $8,000 $11,000 $22,000

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.

 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.

 N/A N/A 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.

 N/A N/A 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

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.

 $16,300 $16,300 $32,600

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.

 $40 $50 50% 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.

 $30 $30 $30 plus 25% of approved cost
THE BLUE CROSS DIFFERENCE

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

Access to care

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.

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Improved care

Blue Cross Coordinated Care Core

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

Health & Well-Being

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

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Plan understanding

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 with PPO plans to use cost-effective providers by using our Find Care tools.

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Resources

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TOOLKITS

Resources to share with your employees

Browse brochures, videos and posters designed to help your employees get the most out of their Blue Cross coverage.

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