PPO (Preferred Provider Organization) plan
PPO plans offer two levels of benefit: Members can select from health care providers who are part of the nationwide Blue Cross Blue Shield PPO Network (preferred), as well as from providers who are out of our network. Members do not need to select a primary care provider or get referrals from a primary care provider to see a specialist.
In-Network
- Health care providers contract with our nationwide network of preferred providers.
- Members generally have a lower cost-share (copayment, deductible, or co-insurance) when they use these preferred providers.
Out-of-Network
- Health care providers are not contracted with the nationwide preferred provider network.
- Members generally have a higher cost-share (copayment, deductible, or co-insurance) and may be billed for the difference between your charge and the allowed amount (balance billing).
- If the member has a Select Blue limited network PPO plan, please refer to the reimbursement information on our limited network page.
- Health care providers are not contracted with the nationwide preferred provider network.
- Members generally have a higher cost-share (copayment, deductible, or co-insurance) and may be billed for the difference between your charge and the allowed amount (balance billing).
- If the member has a Select Blue limited network PPO plan, please refer to the reimbursement information on our limited network page.
EPO (Exclusive Provider Organization) plan
With EPO plans, such as our Advantage Blue plan, members must use health care providers who are part of the Blue Cross Blue Shield PPO Network to receive benefits. With the exception of emergency services, there are no benefits for members who choose to receive services outside of the preferred provider network. Members do not need to select a primary care provider or get referrals from a primary care provider to see a specialist.
