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Preferred Provider Organization - PPO

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PPO is a Capital Blue Cross preferred provider organization (PPO) with an extensive network of physicians and hospitals across the United States. The plan is designed to give access to flat dollar copayments for doctor visits, provide coverage for wellness care, and give you the freedom to receive care without the paperwork hassle of referrals.

In-Network Plan Features

  • Covered individuals may see any provider in the network, including specialists, without selecting a primary care physician or having a referral.
  • Wellness care is covered if it is received from a network provider.
  • Participants pay a small copayment for each doctor visit.

Deductibles, coinsurance payments, and out-of-pocket limits similar to those in a fee-for-service plan apply to other in-network services such as tests and hospitalization.

Out-of-Network Plan Features

  • Participants may receive services from providers who are not part of the network.
  • Charges for out-of-network services, if covered, are subject to higher deductibles, higher coinsurance payments, and balance billing by the provider.
  • Like all of the university’s medical plans, PPO also includes a prescription drug plan (through Express Scripts) and vision care benefits (through DavisVision)

Behavioral Health Care

  • Magellan Behavioral Health will preauthorize behavioral inpatient care and partial hospitalization benefits. To receive reimbursement, services must be preauthorized. Services received out of the plan’s network will be subject to higher deductibles, higher coinsurance payments, and are likely to result in balance billing, as well.

For More Information

  • The highlights of this medical plan, pre-authorization procedures, and preventive care services can be found in the Flexible Benefits Enrollment & Reference Guide.
  • To view the Capital Blue Cross certificate of insurance, which is the most detailed explanation of the plan:
    • Log on to the Campus Portal
    • Select the "Employee" tab
    • Select PPO within the Human Resources channel