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Select Preferred Provider Plan (PPO)

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Select Preferred Provider Plan (PPO)

Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of the benefits is included in the Evidence of Coverage. Please refer to;the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

The Select Preferred Provider Plan (PPO) is a preferred provider organization (PPO) health care plan that offers the flexibility to choose a doctor or hospital and control health care costs. Members save money when they obtain their health care from our large Preferred Provider network, and they can self-refer to any physician or provider in the network.

Advantages
  • Members do not need to choose a primary care physician (PCP) and you will never need a referral.
  • 365 days of hospital coverage
  • Freedom to visit any doctor or hospital outside the network and still be covered; members will just share more of the cost.
  • Access to one of the largest PPO participating provider networks in MD, DC, and VA area, with more than 24,000 participating providers.
  • Fewer paperwork hassles than traditional plans; all Select Preferred Providers and Participating Providers will typically file claims for members.
  • No balance billing when using participating hospitals and providers.
  • Coverage while traveling: The plan offers access to BlueCross BlueShield physicians and hospitals nationwide. This means that the health plan travels with members. When seeing a network provider, there are no claim forms to file.
Preventive Care and Wellness Benefits
  • Annual routine examinations and office visits
  • Well-child care and immunizations
  • Women's health coverage, such as routine mammograms and Pap tests, with no written referrals required for routine gynecological and obstetrical care
  • Men's health coverage, including routine prostate cancer screenings
  • Quarterly wellness magazine
3-Tier Prescription Drug Plan
  • Tier 1 - Generic drugs (lowest out-of-pocket cost) $
  • Tier 2 - Preferred brand name drugs (higher out-of-pocket cost) $$
  • Tier 3 - Non-preferred brand name drugs (highest out-of-pocket cost) $$$

Some plans require coinsurance payments. Refer to the Evidence of Coverage booklet for more information.

Benefit may require deductible and/or annual maximum.

Additional Features
  • No-cost preventive services for children and adults
  • Disease management programs for members with chronic asthma, diabetes, congestive heart failure, coronary heart disease and chronic obstructive pulmonary disease (COPD)
  • Vitality member magazine
  • Health education programs
  • Wellness Discount Program - Learn about Blue365, an exciting program that offers great discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much more.
  • 24/7 Advice: FirstHelp gives 24-hours a day, 7-days a week health care advice from registered nurses who can answer your employees' health care questions and help guide them to the most appropriate care.
Dental Plans May Be Purchased Separately
  • Traditional Dental
  • Preferred (PPO) Dental

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For more information about this plan, contact our Member Services Department at the phone number on your member ID card.