Performance PPO

A 3-tier plan for employer groups located in Adams, Franklin, Lebanon, Lehigh, Northampton and York counties.

Is your group a different size? Shop for group plans.

For groups of 1-50 employees

  • Employees have the lowest out-of-pocket costs when they select designated Performance Plus (PP) in-network providers (WellSpan Health, St. Luke’s University Health Network, Lancaster General Health and Penn State Health).
  • A middle tier of benefits applies to Performance Select (PS) in-network providers.
  • The highest out-of-pocket costs are incurred when employees use out-of-network providers.

Our products have pediatric vision and pediatric dental services embedded.

D/$ = Deductible applies first, then a copay

2024 plans

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold Performance PPO 
1000/0/20

PP - $1,000

PS - $2,000

PP – 0% 
PS – 20%
$8,550

PP - $20

PS - $40

PP - $40

PS - $60

D/$250
Silver QHDHP Performance PPO 
2750/0/15

PP - $2,750

PS - $5,500

PP – 0%

PS – 20%

$7,000

PP - D/$15

PS - D/$30

PP - D/$30

PS - D/$45

D/$350
Silver Performance PPO 
4500/0/30

PP - $4,500

PS - $9,000

PP – 0%

PS – 20%

$9,300

PP - $30

PS - $60

PP - $60

PS - $80

D/$400

2023 plans

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold Performance PPO 
1000/0/20

PP - $1,000

PS - $2,000

PP – 0% 
PS – 20%
$8,550

PP - $20

PS - $40

PP - $40

PS - $60

D/$250
Silver QHDHP Performance PPO 
2750/0/15

PP - $2,750

PS - $5,500

PP – 0%

PS – 20%

$7,000

PP - D/$15

PS - D/$30

PP - D/$30

PS - D/$45

D/$350
Silver Performance PPO 
4500/0/30

PP - $4,500

PS - $9,000

PP – 0%

PS – 20%

$9,100

PP - $30

PS - $60

PP - $60

PS - $80

D/$400