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Performance PPO

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.

$ 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 applies first, then a copay

2025 plans

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

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.

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