PPO-100 is a Capital Blue Cross preferred provider organization (PPO) with an extensive network of physicians and hospitals across the United States. 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. Other covered in-network services, such as tests and hospitalization, are paid in full. 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.
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 health care benefits for PPO 100 participants are available only 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.
Also provided under PPO 100:
- Vision care benefits (through Davis Vision)
The highlights of this medical plan and pre-authorization procedures can be found in the current 2012 Flexible Benefits Enrollment & Reference Guide.
To view the Capital Blue Cross certificate of insurance for this plan, log on to the Campus Portal, select the "Employee" tab, and select PPO 100 within the Human Resources channel .