The active Medical Plan of the Presbyterian Church (U.S.A.) provides members and their enrolled family members with comprehensive medical benefits, including
- preventive care;
- hospital, medical/surgical, and behavioral health coverage;
- prescription drug benefits; and
- resources to improve your health and well-being.
Two medical coverage options are available, and both are administered by Highmark Blue Cross Blue Shield:
- Preferred Provider Organization (PPO) option — You can receive services from any provider without coordinating your care through a primary care physician. The PPO gives you access to a network of doctors, hospitals, and other medical facilities with which the plan has a contractual relationship. You generally pay less — usually a lot less — if you use these network providers.
- Exclusive Provider Organization (EPO) option — You must use network providers (the same BCBS network as the PPO). Costs for services from out-of-network providers are not covered. If you visit an out-of-network provider when you have access to a provider that participates in the network, you are responsible for all costs incurred.
The types of services covered under each option are largely the same, although the cost-sharing provisions differ.
A third program, medical continuation, allows you to continue coverage for a limited time and on a self-paid basis when you terminate your plan membership.