BluePreferred for PPO for Individuals Plans
PW_AD071348
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. |
| One of the largest PPO networks in Nevada with over 3,900 doctors and specialists and more than 32 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 information, see the Benefits-at-a-glance chart below.
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BluePreferred PPO 1000/2000 benefits-at-a-glance
These amounts show your share of costs after deductible, if any.
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Plan Benefit
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In-Network
Receive negotiated savings
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Out-of-Network3
Pay higher costs
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Annual Deductible
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Single Member
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$1,000 / $2,000
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$2,000 / $4,000
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Family Maximum
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$3,000 / $6,000
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$6,000 / $12,000
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Annual
Out-of-Pocket Limit
(in addition to deductible)
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Single Member
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$3,000 / $4,500
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$6,000 / $7,500
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Family Maximum
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$6,000 / $9,0001
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$12,000 / $15,0001
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Lifetime Maximum
(combined for in-network and out-of-network)
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Health plan pays up to $2 Million per member
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Covered Services
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In-Network
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Out-of-Network3
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Doctors’ Office Visits
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$35 / $40 copay2
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50%
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Professional Services
(X-ray, lab, anesthesia, surgeon, etc.)
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20% / 30%
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50%
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Hospital Inpatient
(overnight hospital stays)
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20% / 30%
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50%
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Hospital Outpatient
(if you don’t stay overnight)
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20% / 30%
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50%
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Emergency Room Services
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20% / 30%
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50%
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Maternity
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not covered
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Preventive Care
(specific routine tests based on national recommendations)
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Adult
Services
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Mammogram:
Any charges over Anthem’s $85 payment per test
Pap test:
Any charges over Anthem’s $75 payment per test
Prostate screening:
Any charges over Anthem’s $65 payment per test
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Mammogram:
Any charges over Anthem’s
$85 payment per test
Pap test: 50%
Prostate screening:
Any charges over Anthem’s
$65 payment per test
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Children’s
Services
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20% / 30% for
age-appropriate visits and routine immunizations
(deductible waived)
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50% for age-appropriate visits
and routine immunizations
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Chiropractic Service
($200 maximum annual benefit per member)
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20% / 30%
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50%
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Prescription Drug Coverage
(see brochure for more information)
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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 1-866-412-9149, Monday – Friday, 6:30 a.m. – 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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