The BlueCard® PPO (preferred provider organization), administered by Highmark Blue Cross Blue Shield, and CIGNA Behavioral Health (CBH) are the primary network of physicians, hospitals, and other healthcare providers for Medical Plan participants. You can see any primary care physician, counselor, or specialist without a referral from your primary care physician. Verify in advance that any provider you plan to visit participates in the network to ensure maximum reimbursement:
- Call Highmark at 888-835-2959.
- Call CBH at 866-640-2772.
- Call the Board at 800-773-7752.
- Visit the "Find Providers" section of www.highmarkbcbs.com.
- Visit www.cignabehavioralhealth.com.
- Contact your provider's office.
Copays and Deductibles
Members living in network who use network providers and members living in non-network areas have a:
- $0 copay for annual covered preventive care visits to primary care physicians and gynecologists for members and covered spouses and dependents.
- $25 copay for a network primary care, family practice, or internal medicine physician's office visit or behavioral health counseling session
- $35 copay for an office visit to a network specialist
The amount you pay for an office visit is not applied to the deductible or to the copayment limit*; you pay for an office visit even if you have satisfied your copayment limit for the year. All tests and procedures performed in the course of an office visit are subject to the Plan's deductible and copayment provisions.
* Except for the copay for an office visit, your portion of eligible expenses accumulates until you reach the copayment limit. When you reach that limit, you receive 100% reimbursement for all eligible expenses for the balance of the year.
Members living in network areas who use out-of-network providers pay 50% of the plan allowance. The benefits are reimbursed based on the contracted rate, so members may be subject to billing from the physician if the charge is above the plan allowance.
For the BlueCard PPO network, the Board reimburses at the following rates:
- the PPO contracted rate for network services
- the Blue Cross Blue Shield PPO contracted rate for out-of-network services
- up to 120% of the PPO contracted rate for non-network services
