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For groups of 51-99 employees
Built using clinical data to identify high-performing providers, Performance PPO plans save employers an average of 6 to 7% on premium costs over comparable PPO plans.
$ Performance Plus (PP) providers result in the lowest out-of-pocket costs for employees:
- WellSpan Health
- St. Luke’s University Health Network
- Lancaster General Health
- Penn State Health
$$ Performance Select (PS) providers result in higher out-of-pocket costs for employees:
Includes all remaining in-network providers not designated as Performance Plus.
$$$ Out-of-Network providers result in the highest out-of-pocket costs for employees.
Employees can easily locate both Performance Plus and Performance Select providers using MyCare Finder at CapitalBlueCross.com.
D = Deductible
D/20% = Deductible applies first, then 20% coinsurance
D/$ = Deductible applies first, then a copay
2025 plans
| Plan |
HRA option |
Deductible1 |
Coinsurance |
Out-of-pocket max |
PCP |
Specialist |
Emergency room |
| Performance PPO 1000/0/20 |
No |
PP - $1,000
PS - $2,000
|
PP - 0%
PS - 20%
|
$8,550 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| Performance PPO 3000/0/20 |
No |
PP - $3,000
PS - $6,000
|
PP - 0%
PS - 20%
|
$8,550 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| Performance PPO 6000/0/20 |
No |
PP -$6,000
PS - $9,000
|
PP - 0%
PS - 20%
|
$9,100 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| QHDHP Performance PPO 2000/0/02 |
No |
PP - $2,000
PS - $4,000
|
PP - 0%
PS - 20%
|
$7,000 |
PP - D
PS - D/20%
|
PP - D
PS - D/20%
|
D/$250 |
| QHDHP Performance PPO 3500/0/02 |
No |
PP - $3,500
PS - $7,000
|
PP - 0%
PS - 20%
|
$7,500 |
PP - D
PS - D/20%
|
PP - D
PS - D/20%
|
D/$250 |
