Blue Cross Physician Choice PPO | PCPPO Cost Sharing Levels Explained

Blue Cross Physician Choice PPO is built around communities of doctors and hospitals committed to providing members with affordable
and high-quality health care services. These communities are called Organized Systems of Care or OSCs. With this plan, members have choices that determine their share of the cost. If you’re not quite sure how cost can affect your health care, it’s time you got up to speed. Here are a few important facts about your Physician Choice PPO plan that will help you make the most of your plan and benefits. First of all, what is cost share? Simply put, it is the amount members pay for covered medical services. The term “cost share” commonly includes deductibles, coinsurance, and copayments. It applies to benefits covered in your health plan. With Physician Choice PPO, you have different levels of cost share based on the doctors you choose, Level 1, Level 2, and out of network cost share. To get the Level 1 cost share, Physician Choice PPO members must first choose a primary care doctor within a Level 1 OSC and then use doctors and hospitals within that Level 1 OSC. Members have two choices to stay within the Level 1 cost share. 1: They can receive care from any doctors, specialists and hospitals within their primary care doctor’s Level 1 OSC without a referral. Or, 2: with a referral from their primary care doctor, they can use any doctors and hospitals outside of their Level 1 OSC but within the broader Blue Cross PPO network. Without a referral members will pay Level 2 cost share. Members will also pay Level 2 cost share
if they select a primary care doctor that is not in a Level 1 OSC, or if they do not make a primary care doctor selection. As with any PPO plan, members who go out of network will pay the highest cost share. Physician Choice PPO is all about giving members choice, flexibility and affordability. To learn more about Physician Choice PPO plans and more tips on how to maximize your plan visit

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