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.
- 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.
- 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
- 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.
- 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.
- Traditional Dental
- Preferred (PPO) Dental
- BlueVision Plus
For more information about this plan, contact our Member Services Department at the phone number on your member ID card.