BluePreferred PPO
PW_A072243
BluePreferred is a preferred provider (PPO) plan. This means, you can see any doctor and BluePreferred will pay a portion of the cost. You’ll save even more when you choose a doctor from the PPO network. Other BluePreferred PPO features include:
 | A choice of deductibles, which gives you more control over your premium costs. |
| Access to one of the largest PPO networks in Colorado with more than 6,500 doctors and 80 hospitals |
| No referrals needed to see in-network specialists |
| Preventive care benefits for well-child physician office visits, immunizations for children, and health screenings such as mammograms, pap tests and prostate cancer screenings. |
| Non-routine doctor visits are covered at 100% after your copay (certain exceptions apply). |
| Prescription drug coverage for both generic and brand-name drugs with no brand-name deductible. |
| Dental and Term Life coverage options for complete protection and peace of mind |
For more details, see the benefits-at-a-glance chart below.
BluePreferred benefits-at-a-glance
These amounts show your share of costs after deductible, if any.
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In-Network
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Out-of-Network3
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Annual
Deductible Choices
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Individual
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$500/$1,000/$2,000/$3,000
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$1,000/$2,000/$4,000/$6,000
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Family
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$500/$1,000/$2,000/$3,000
per family member
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$1,000/$2,000/$4,000/$6,000
per family member
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Annual
Out-of-Pocket Limit
(includes deductible)
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Individual
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$1,500/$2,000/$3,000/$5,000
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$3,000/$4,000/$6,000/$10,000
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Family
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$1,500/$2,000/$3,000/$5,000 per family member1
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$3,000 / $4,000/ $6,000/ $10,000 per family member1
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Lifetime Maximum
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Plan pays up to $2 Million per member
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Covered Services
The amounts shown are your share of costs after any deductible
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In-Network
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Out-of-Network3
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Doctors’ Office Visits
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$25 copay (with $500/$1000/$2,000 deductible plans)2
OR
20% coinsurance (with $3,000 deductible plan)2
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40%
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Professional Services
(x-ray, lab, anesthesia, surgeon, etc.)
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20%
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40%
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Hospital Inpatient
(overnight hospital stays)
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20%
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40%
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Hospital Outpatient
(if you don’t stay overnight)
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20%
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40%
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Emergency Room Services
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20%
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40%
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Maternity
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not covered
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Preventive Care
Services
(including appropriate screening for breast, cervical, ovarian and prostate cancer)
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Adult Services
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Deductible waived for the following:
Mammogram or PSA test:
No cost to you
Pap test: Any charges over Anthem’s $75 payment per test PLUS office visit copay/coinsurance shown above
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Any charges in excess of Anthem’s Maximum Benefit Allowance (MBA)
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Children’s
Services
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20% for age-appropriate visits and routine immunizations (deductible waived)
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40% for age-appropriate visits and routine immunizations (deductible waived)
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Chiropractic Services
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not covered
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Prescription Drug Coverage
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Generic: $15 copay
Brand-name: $40 copay
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not covered
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For more information:
| Call 1-866-293-2892, Monday through Friday from 6:30 a.m. to 5:30 p.m. (PST) to speak to a licensed agent |
| Contact your local Anthem Blue Cross and Blue Shield agent |
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