Plan types

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Plan types available by county of residence

County of residence HMO Capital Advantage EPO Valley Advantage EPO PPO Choice PPO

Cumberland, Dauphin, and Perry



 

 


Lehigh and Northampton


 


 


Lancaster


 

 


Only Catastrophic PPO available

Adams, Berks, Centre, Columbia, Franklin, Fulton, Juniata, Lebanon, Mifflin, Montour, Northumberland, Schuylkill, Snyder, Union or York


 

 

 



Health maintenance organization (HMO)

Available in all 21 counties.

Choose a primary care physician (PCP) for routine care. Like check-ups or sick appointments. Your PCP will refer you to other healthcare providers when you need specialty care. If you need care from a specialist in the network or a diagnostic service such as a lab test or X-ray, your PCP will provide you with a referral. Services for out of network providers are generally not covered unless otherwise provided in the contract (e.g., emergency services).


Valley Advantage exclusive provider organization (EPO)

Available in Lehigh and Northampton counties.

These health plans provide high quality health services using an exclusive provider network depending on the county in which you reside. Services for out of network providers are generally not covered unless otherwise provided in the contract (e.g., emergency services).

Valley Advantage EPO provides benefits and services using doctors and hospitals of St. Luke’s University Health System and other independent practices throughout the Lehigh Valley.


Capital Advantage exclusive provider organization (EPO)

Available in Cumberland, Dauphin and Perry counties.

These health plans provide high quality health services using an exclusive provider network depending on the county in which you reside. Services for out of network providers are generally not covered unless otherwise provided in the contract (e.g., emergency services).

Capital Advantage EPO provides benefits and services using the UPMC Pinnacle network of professional providers and facilities.


Preferred provider organization (PPO) Choice

Available in Lancaster county.

These health plans provide extra savings using a tiered network with the flexibility of a PPO. You get extra savings when you get your care from certain healthcare providers. For greater savings and lower out-of-pocket costs, visit PPO Choice 1 providers. PPO Choice 2 providers will offer you access to more care, giving you flexibility and convenience to choose additional doctors and hospitals at a slightly higher out-of-pocket cost. Highest out-of-pocket cost will occur if you use out-of-network providers.


Preferred provider organization (PPO)

Available in all counties except Lancaster.

With a PPO you have the most flexibility to choose which doctors you want to see. Choose an in-network provider to keep your out of pocket costs down. You do not need a referral to seek specialty care.


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