PPO Plus 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 and 10 percent coinsurance for all other covered in-network services, such as tests and hospitalization.
- Participants may also receive services from providers who are not part of the network. However, charges for out-of-network services, if covered, are subject to deductible and coinsurance payments, as well as balance billing by the provider.
Behavioral (Mental) Health Care
Behavioral health care benefits for PPO Plus participants are available through Integrated Behavioral Health (IBH). IBH manages the benefits through assessment, referral, case management, and claims payment. IBH uses their nationwide network of behavioral health professionals and treatment programs and facilities.
To receive reimbursement, all services must be preauthorized and received within the network. There are no out of network benefits available.
For More Information
- The highlights of this medical plan, pre-authorization procedures, and preventive care services can be found here:
- 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 Plus within the Human Resources channel