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PreferredBlue® PPO High Option I
OverviewThe PreferredBlue® PPO (Preferred Provider Organization) plan makes managed care easy! PreferredBlue® is designed for people who want the greatest flexibility and convenience within a network-based program. PreferredBlue® gives members the freedom to choose any doctor, specialist or hospital. When a member or a covered dependent needs medical care, the member can choose between two levels of service: in-network or out-of-network. If a member uses an "in-network provider", benefits will be received at the highest level of coverage. There are no deductibles or coinsurance, just a $10 Co-Pay for physician office visits. Benefits for eligible "out-of-network" services are subject to the deductible and coinsurance provisions of the plan. Benefits at a GlanceA PPO offers two levels of benefits. If you receive services from a provider who is in the PPO network, you'll receive the highest level of benefits. If you receive services from a provider who is not in the PPO network, you'll receive the lower level of benefits. In either case, you coordinate your own care. There is no requirement to select a Primary Care Physician (PCP) to coordinate your care. Below are specific benefit levels. Wish to have a printable version of this benefit grid? A simple click will open a pdf version...PreferredBlue PPO The benefit summary outlines the principal features of the program. It should not be considered the contract of benefits and provisions. Please refer to your member handbook for a complete description of benefits or contact us for a further explanation. Provider NetworkMembers can use the RatesTo determine premium rates, Highmark Blue Cross Blue Shield uses a demographic rating method based on the following factors: business location, the number of eligible employees enrolling, the average age of all covered employees, and industry classification. Please contact the Council's Employee Benefits Group to determine your specific rates. Highmark DisclaimerHighmark Blue Cross Blue Shield® is an independent licensee of the Blue Cross and Blue Shield Association serving businesses and residents in western Pennsylvania. Highmark® is a registered service mark of Highmark Inc. Blue Cross and Blue Shield® and the cross and shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Blues on CallSM is a service mark of the Blue Cross and Blue Shield Association. This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.
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