Premier PPO Health Plans
If you have young children -- or are planning to have a family – you’ll find that Premier PPO health plans were created with your specific needs in mind. Coverage focuses on the preventive care services your family needs to stay healthy. Copays are not only designed to be affordable, they make it easy to predict and plan for your out-of-pocket expenses.
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Designed to fit your health care needs and budget. Choose from six plans with different deductibles ranging from $750 to $20,000. The higher your deductible, the lower your premiums will be.
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One of the largest provider networks in Georgia. With more than 34,000 doctors and 165 hospitals, it’s easy to stay within our network for your health care needs. And our negotiated rates will lower your share of medical costs. |
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Coverage that travels with you. No matter where life takes you, your health coverage goes with you. And providers in our network across the country help make it easy to get the care you need. |
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No referrals or paperwork. You won’t need a referral to see a specialist. And there are no claims or paperwork when you use one of our network providers. |
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Preventive care benefits. To help you keep your family healthy, copays are designed to be affordable and apply to routine physical exams, an annual vision exam, health screenings, childhood immunizations and well-child visits. |
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Built-in prescription benefits. From generic-only savings to brand-name and specialty coverage, benefits are available to help you save on the high cost of prescription drugs. |
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Optional dental and term life insurance. For extra security, you can choose to add one of our popular dental and term life coverage options. |
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Experience you can rely on. One of the most trusted names in health coverage, Blue Cross and Blue Shield of Georgia has been providing quality health benefits to state residents for over 70 years.
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Premier PPO benefits-at-a-glance
This chart is a brief summary of benefits and is not intended to be a full disclosure of benefits.
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In-Network
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Out-of-Network
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Calendar Year Deductible Choices
(separate deductibles apply for in-network and out-of-network)
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Individual
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$750
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$1,500
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$2,500
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$750
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$1,500
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$2,500
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$5,000
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$10,000
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$20,000
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$5,000
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$10,000
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$20,000
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Family
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$1,500
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$3,000
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$5,000
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$1,500
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$3,000
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$5,000
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$10,000
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$20,000
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$40,000
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$10,000
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$20,000
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$40,000
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Calendar Year Out-of-Pocket Maximum
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Individual
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Your deductible plus
$2,500*
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Your deductible plus
$7,500
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Family
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Your deductible plus
$5,000*
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Your deductible plus
$15,000
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Lifetime Maximum
(maximums are combined for in-network and out-of-network)
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Health Plan pays up to $7 Million per member
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Covered Services - These amounts show your share of costs after deductible, if any.
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In-Network
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Out-of-Network
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Doctors’ Office Visits including preventive visits
(Preventive visits for children through age 5 are covered
before the deductible.)
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$35 copayment
Not subject to deductible
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40%
(30% with $10,000 or $20,000 deductible)
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Child Preventive Services (through age 5)
(Services such as immunizations, laboratory testing.)
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%20
Not subject to deductible
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40%
Not subject to deductible
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Preventive Services (age 6 and over)
(Services such as PSA test, Colorectal screening, mammograms,
pap test, flu shot and colonoscopy.)
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%20
Not subject to deductible
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40%
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Professional Services
(x-ray, lab, anesthesia, surgeon, diagnostics, etc.)
Hospital Inpatient
(overnight hospital stays)
Hospital Outpatient
(if you don’t stay overnight)
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20%
(0% with $10,000 or $20,000 deductible)
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40%
(30% with $10,000 or $20,000 deductible)
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Emergency Room Services
(Accidental injury or Medical Emergency as defined by BCBSGa)
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20%
(0% with $10,000 or $20,000 deductible)
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Maternity
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NOT COVERED; OPTIONAL COVERAGE AVAILABLE
Separate 12 months waiting Period
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Physician care - 20%
Hospital Facility - $3,000 copay, not subject to deductible
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Physician care - 40%
Hospital Facility - 30%
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Dental
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Optional coverage available
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Life
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Optional coverage available
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Prescription Drug Coverage
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In-Network
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Out-of-Network
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Generic Prescription Drug Coverage
(see brochure for more information)
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$15 copay (or 40%, whichever is greater)
Not subject to deductible
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Comprehensive
(Specialty and Brand name)
Prescription Drug Coverage
(see brochure for more information)
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Separate $250 deductible per member per calendar year for
brand-name or specialty drugs
$15 copay or 40% (whichever is greater)
plus difference in allowable charge if Brand is chosen over an available generic
Out of pocket maximum $300 per prescription and $4,000 per person per calendar year
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* For Premier, if you choose the $10,000 or $20,000 individual deductible or the $20,000 or $40,000 family deductible, your Calendar Year Out-of-pocket Maximum is your deductible only.
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