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ACA Value PPO

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.

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

ACA Value PPO benefits by network.
In-Network Out-of-Network
Group Number 006171 006171
Deductible $1,500 member*, $3,000 family $1,500 member*; $3,000 family
Coinsurance 20% 40%
Out-of-Pocket (OOP) Maximum $3,000 member*, $7,350 family $6,000 member; $16,000 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/Conexis will administer the billing process.  Monthly premiums must be paid on time.

The montly premiums of the ACA value PPO plan by the family members insured.
You You + Spouse You + Child(ren) You + Spouse + Child(ren)
$99 $683 $520 $1,219

Benefits

Prescription coverage
Discounts
  • 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
Immunizations
  • 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