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This plan gives you the flexibility to choose any doctor/hospital that you wish without requiring a primary care physician (PCP) or referrals. If you choose a Blue Cross doctor, you will be charged the in-network rates.

Non-benefits eligible faculty and staff who have worked an average of 30 hours per week during a 12-month initial measurement period (first 12-months) will become eligible for this plan.  To remain eligible, faculty and staff must continue to work an average of 30 hours per week during a 12-month standard measurement period (fiscal year).  Those who qualify will be invited to participate via a letter to their home address via USPS.

This is a summary of the plan benefits. Complete benefit information is available in the BCBS PPO Value PPO Booklet and Summary of Benefit Coverage (SBC).

ACA Value PPO benefits by network.
In-Network Out-of-Network
Group Number 006171 006171
Deductible $2,000 member*, $4,000 family $3,000 member*; $6,000 family
Coinsurance 20% 40%
Out-of-Pocket (OOP) Maximum $3,000 member*, $8,000 family $7,500 member; $20,000 family
Prescription OOP Maximum Included in health OOP max N/A
Wellness Checkup Covered 100% according to age/sex guidelines Deductible + 40% coinsurance
Office Visit Deductible + 20% coinsurance Deductible + 40% coinsurance
Emergency Room Costs Deductible + 20% coinsurance Deductible + 20% coinsurance

*All health care copays apply toward the out-of-pocket maximums.

Find a Doctor

In-and-out of network
  1. Navigate to the Provider Finder
  2. Select the Group health plan and choose PPO

Those on this plan will be billed on a monthly basis for the premiums owed.  Our billing vendor Wage Works/WageWorks will administer the billing process.  Monthly premiums must be paid on time.

The monthly premiums of the ACA value PPO plan by the family members insured.
You You + Spouse You + Child(ren) You + Spouse + Child(ren)
$103 $748 $569 $1,341


Prescription coverage
  • Vision discount - program available through Davis Vision
  • Blue Discount Program - offers a variety of discounts on gym memberships, alternative medicine and hearing aids
  • Hearings aids discounts available with TruHearing at 866-687-2020
  • Covered under the Well Child Care provisions for children up to age 16
Routine mammogram and pap smear
  • Covered at 100% in network, 60% out of network. Deductible does not apply
Laboratory tests and x-rays
  • Coinsurance after deductible is met
Physical therapy and chiropractic care
  • Coinsurance after deductible is met
  • Member's condition must show continued improvement with physical therapy
Minor surgery in doctor's office or outpatient surgical operations
  • Coinsurance after deductible is met
Diabetes treatment
  • Covered at coinsurance after deductible is met
    • Self management training services rendered by a physician or licensed health care professional with expertise in diabetes management
    • Regular foot care examinations by a physician or podiatrist

Exclusion examples

  • Hearings aids; discounts available with TruHearing at 866-687-2020
  • Custodial nursing home care
  • Cosmetic care except for the correction of congenital deformities or for conditions resulting from accidental injuries, tumors or disease
  • For a comprehensive list of exclusions, contact BCBS at 800-327-8497