The Traditional and Deductible PPO Plans provide benefits for you and your covered dependents through Empire Blue Cross. In a PPO plan, hospitals, physicians, and other health care providers agree to join the plan's provider network. These in-network providers agree to charge reduced fees to plan participants, and the plan pays a higher percentage of the cost of care received from these providers. The plan gives you the flexibility to visit any providers you choose, but visiting in-network providers can save you money and the time associated with filing claims for reimbursement. For the traditional PPO, with most types of care received in-network, you pay only a copayment at the time you receive services (within plan limits). For the Deductible PPO, your deductible and coinsurance is lower for in-network services and there is a copayment for office visits.
PPO Benefits Guide
If you enroll in either PPO plan, you will receive a Benefits Guide from your campus benefits office. The PPO Benefits Guide will contain Your Benefits at a Glance that outlines for you in chart format an overview of your coverage, including in-network and out-of-network benefit levels; general information about the provider network; and benefits sections that describe in detail the health care services covered under the PPO Plan.
Prescription drug benefits for both PPO plans are administered by Express Scripts, and have the same copayments for both plans.
Both plans offer a gym membership fee reimbursement of up to $300 annually. See the gym reimbursement brochure for additional information. To file for reimbursement, you'll need the facility verification form and the gym reimbursement form. All these are also available when you log in to www.empireblue.com.
To Find a Preferred Provider for either PPO:
Central and Western New York and outside New York State:
Enter the Member section of the Empire Blue Cross Web site and click on "Find a Doctor," then click on "Across the Country."
Eastern New York:
Enter the Member section of the Empire Blue Cross Web site and click on "Find a Doctor," then click on "Empire's Local Area."