Consumer Choice PPO

 

The Consumer Choice PPO Plan offers flexibility to see any health care provider you choose, however when you go to an in-network BlueCross BlueShield provider you are going to receive services at a negotiated discounted fee.

The Consumer Choice PPO Plan is a qualified high deductible health plan (HDHP), which entitles you to a health savings account (HSA). Be sure to review the HSA section for more information!

The Consumer Choice PPO Plan has a $2,700 deductible for employee coverage or $5,450 deductible for all other tiers. One family member or a combination of family members can satisfy the family deductible and the full family deductible must be met before post deductible benefits are paid.

Coverage at a Glance

​Out-of-Pocket Expenses

​In-Network

​Out-of-Network

​Deductible

​Individual: $2,700

Family: $5,450 Maximum

​Annual Out-of-Pocket Maximum
(Includes deductible)

​Individual: $2,700

Family: $5,450

​Individual: $5,400

Family: $10,900


 

Benefits

​In-Network

​Out-of-Network

​Coinsurance Paid After Deductible
(Applies to all professional services except those noted below.)

Plan Pays 100%​

​You Pay 40%

Office Visit Copays
(Copays do not apply to deductible or out-of-pocket maximum)

Subject to Deductible and Coinsurance

​Lab work/Professional Services

Subject to Deductible and Coinsurance, then Plan Pays 100%

​Emergency Room Visit Copayment

Subject to Deductible and Coinsurance​

​Wellness Benefit

​100% of In-Network Eligible Charges

​Periodic Preventive Services

​100% of Eligible Charges –

not subject to deductible or maximum​

​Pre-Existing Condition Exclusion

None​


 

What is a Deductible?

The deductible is the amount you must pay for covered medical services each year before the medical plan begins to pay benefits. The deductibles under the PPO Plans start over each Jan. 1.

Coverage for an Individual

  • If you elect coverage for yourself, the individual deductible applies to you. You must pay for covered medical services for yourself.

  • The plan will not begin to pay for benefits until you meet the individual deductible.

Coverage for an Individual and One or More Dependents

  • If you elect coverage for yourself and one or more eligible dependents, a family deductible applies to all as a single-family unit.

  • Full family deductible must be met by at least one person before the plan begins to pay.

  • After the deductible has been met, the plan will pay for benefits for the rest of the family members.

​ ​Benefit Limits

​Maximum Lifetime Benefit (unless noted)

​Unlimited

​Substance Abuse Treatment

​Subject to Deductible and Coinsurance

​Mental Illness

​Subject to Deductible and Coinsurance

​Chiropractic

​Subject to Deductible and Coinsurance

​Hearing Aids

​$1,500 every three years per covered person
Subject to Deductible and Coinsurance

​Temporomandibular Joint Dysfunction & related disorders

​Subject to Deductible and Coinsurance

​Physical, Occupational and Speech Therapy

​Subject to Deductible and Coinsurance


 

Coverage through Caremark network pharmacy or mail order only
​Retail
(30-day supply)
​Retail
(90-day supply)
Mail Order
(90-day supply)

​Generic Copay
Preferred Brand Copay
Non-Preferred Brand Copay

Subject to same deductible and coinsurance
as other medical benefits ​ ​ ​


 


 

 More Information