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PPO plan options

Flexible. Easy to use. No referrals.

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For groups of 1-50 employees

Give employees affordable health insurance and freedom of choice. Members see physicians and select hospitals of their choice with flat-rate copayments for routine office visits. PPO members have access to Virtual Care (for only a $5 copay, or less) and wellness programs, including Healthy Blue Rewards and more.

Our products have pediatric vision and pediatric dental services embedded.

D/$ = Deductible applies first, then a copay.

2021 plans

Platinum

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Platinum PPO 0/0/15 $0 0% $6,900 $15 $30 $150
Platinum PPO 250/0/15 $250 0% $6,900 $15 $30 D/$200

Gold

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold Simple PPO 0/0/251 $0 0% $8,550 $25 $50 $200
Gold PPO 0/0/20 $0 0% $8,550 $20 $40 $300
Gold PPO 500/0/25 $500 0% $8,550 $25 $55 D/$350
Gold PPO 1000/0/25 $1,000 0% $8,550 $25 $50 D/$250
Gold PPO 2000/0/20 $2,000 0% $8,550 $20 $40 D/$250
Gold PPO 2000/20/20 $2,000 20% $8,550 $20 $40 D/$250
Gold PPO 3000/0/15 $3,000 0% $8,550 $15 $30 D/$150
Gold Shared Deductible 
PPO 3000/0/25-5002		 $3,000 0% $8,550 $25 $60 D/$250

Silver

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Silver PPO 4000/0/45 $4,000 0% $8,550 $45 $75 D/$400
Silver PPO 5000/0/40 $5,000 0% $8,550 $40 $65 D/$350
Silver PPO 6000/0/35 $6,000 0% $8,550 $35 $65 D/$350

2020 plans

Platinum

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Platinum PPO 0/0/15 $0 0% $6,650 $15 $30 $150
Platinum PPO 250/0/15 $250 0% $6,650 $15 $30 D/$200

Gold

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold PPO 0/0/25 $0 0% $6,650 $25 $50 $300
Gold PPO 500/0/20 $500 0% $6,650 $20 $40 D/$250
Gold PPO 1000/0/25 $1,000 0% $7,900 $25 $50 D/$250
Gold PPO 2000/0/20 $2,000 0% $7,900 $20 $40 D/$250
Gold PPO 2000/20/20 $2,000 20% $7,900 $20 $40 D/$250
Gold PPO 3000/0/15 $3,000 0% $7,900 $15 $30 D/$150
Gold Shared Deductible 
PPO 3000/0/25-5002		 $3,000 0% $7,900 $25 $50 D/$250

Silver

Plan Deductible Coinsurance Out-of-pocket max PCP Specialist Emergency room
Silver PPO 3500/0/45 $3,500 0% $7,900 $45 $75 D/$400
Silver PPO 4000/0/35 $4,000 0% $7,900 $35 $65 D/$350
Silver PPO 5000/0/35 $5,000 0% $7,900 $35 $65 D/$350
Silver PPO 5000/20/35 $5,000 20% $7,900 $35 $65 D/$350
Silver PPO 6000/0/35 $6,000 0% $7,900 $35 $65 D/$350

1Gold Simple PPO 0/0/25 is a new plan design for 2021. It features copays for nearly all services, in lieu of any deductible or coinsurance for in-network medical services, and free Virtual Care visits when using Capital Blue Cross's Virtual Care platform.

2On a single plan, Capital Blue Cross covers the first $500 of the deductible for the member, who is then responsible for the remaining $2,500 deductible.

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