| 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 BlueCard 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 screening
- 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:
- Disease management programs for members with chronic asthma, diabetes, congestive heart failure, coronary heart disease and chronic obstructive pulmonary disease (COPD)
- Quarterly wellness magazine
- Health education programs
- Great Beginnings program for expectant mothers
- Discounts on alternative therapies: Options provides discounts on alternative therapies including acupuncture, massage therapy and chiropractic care. It also provides discounts for fitness center memberships and weight loss programs.
- 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.
Vision Benefits (Vision benefits only available on enhanced SPPP product):
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