Each option has different monthly premiums and cost sharing, or out-of-pocket costs for copays, deductibles and coinsurance.
You won’t pay anything for eligible preventive care for all health plan options. It’s covered at 100% if you use an in-network provider. Here’s a comparison of the different PPOs:
Premier PPO – Highest premiums, but you pay less for copays at the doctor's office and pharmacy than the Standard PPO and less for coinsurance.
Standard PPO – Lower premiums than the Premier PPO, but you pay more for copays at the doctor’s office and pharmacy.
Limited PPO (local education and local government only) – Lower premiums than the other PPOs, but you’ll pay more out of pocket for your deductible, copays and coinsurance compared to the other PPOs.
NEW: Copay PPO (local education and local government only) –
- With the Copay PPO, enrolled members will have lower premiums and no deductible.
- Members will pay simple, predictable copay costs, so they’ll know what care will cost ahead of time.
- Copay PPO members will use BlueCross BlueShield Network S providers. These providers will be in two different tiers— members will pay less when they choose providers in Tier 1 versus Tier 2.
- Copay PPO members will use the CVS Value Formulary for prescription drugs. This formulary has only two tiers and covers generic and most preferred brand-name drugs. Coinsurance for weight-loss and specialty drugs will apply with this plan.
- Copay PPO behavioral health and substance use services are covered and administered by Optum Behavioral Health.
- With the Copay PPO, there are out-of-pocket maximums to protect members from high costs.
- Details about the new Copay PPO are found on the Health webpage, and you can watch a video to learn more.
For information on covered and excluded services and how the plans work, view the BCBST and Cigna member handbooks and plan documents on the Publications webpage. Medical necessity determinations may vary between BCBST and Cigna.