A 3-tier plan for employer groups located in Adams, Franklin, Lancaster, Lebanon, Lehigh, Northampton and York counties.
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For groups of 1-50 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.
Includes all remaining in-network providers not designated as Performance Plus.
Employees can easily locate both Performance Plus and Performance Select providers using MyCare Finder at CapitalBlueCross.com.
D/$ = Deductible applies first, then a copay
Plan | Deductible | Coinsurance | Out-of-pocket max | PCP | Specialist | Emergency room |
---|---|---|---|---|---|---|
Gold Performance PPO 1000/0/201 |
PP - $1,000 PS - $2,000 |
PP – 0% PS – 20% |
$8,550 |
PP - $20 PS - $40 |
PP - $40 PS - $60 |
D/$250 |
Silver QHDHP Performance PPO 2750/0/152 |
PP - $2,750 PS - $5,500 |
PP – 0% PS – 20% |
$7,000 |
PP - D/$15 PS - D/$30 |
PP - D/$30 PS - D/$45 |
D/$350 |
Silver Performance PPO 4500/0/301 |
PP - $4,500 PS - $9,000 |
PP – 0% PS – 20% |
$9,200 |
PP - $30 PS - $60 |
PP - $60 PS - $80 |
D/$450 |
2024 plans
Performance PPO plans are not available in Lancaster county in 2024.
Plan | Deductible | Coinsurance | Out-of-pocket max | PCP | Specialist | Emergency room |
---|---|---|---|---|---|---|
Gold Performance PPO 1000/0/20 |
PP - $1,000 PS - $2,000 |
PP – 0% PS – 20% |
$8,550 |
PP - $20 PS - $40 |
PP - $40 PS - $60 |
D/$250 |
Silver QHDHP Performance PPO 2750/0/15 |
PP - $2,750 PS - $5,500 |
PP – 0% PS – 20% |
$7,000 |
PP - D/$15 PS - D/$30 |
PP - D/$30 PS - D/$45 |
D/$350 |
Silver Performance PPO 4500/0/30 |
PP - $4,500 PS - $9,000 |
PP – 0% PS – 20% |
$9,300 |
PP - $30 PS - $60 |
PP - $60 PS - $80 |
D/$400 |
1The prescription drug plan is Rx 0, which does not require any deductible on prescription drugs -- only fixed copays.
2This plan includes a prescription drug plan with an integrated medical/Rx deductible. After the deductible is met, copays apply. The deductible on the family High Deductible Health Plan is not embedded.