BCBS Coupe PPO
Last Updated January 13, 2025
Jump to: Overview BCBS Coupe PPO at a Glance
Overview
Key features of the BCBS Coupe PPO option include:
- Control over your health care. BCBS Coupe PPO shows you the price for covered medical services.
- A flat dollar copay. The amount depends on which provider you choose. With BCBS Coupe PPO, you can easily locate high-quality providers at a predetermined cost for all services — from checkups to advanced procedures.
- No deductibles, no coinsurance for medical services, and no add-ons or unexpected bills.
- Easy payments. You get one statement at the end of the month and the option to pay your medical bills over time with 0% financing. In addition, you can pay how you prefer — online or by mail.
- Provider metrics that can lead to better health outcomes.
- Your own Health Valet who will help you navigate your health care journey with confidence. Your Health Valet can help you:
- Find a high-quality provider
- Coordinate appointments with providers or specialists
- Answer questions about the cost of care before your visit with a provider
- Answer questions on billing or coverage information
- Connect you with a Personal Health Assistant
Prescription coverage works like it always has — you pay a portion of the cost through copays and coinsurance at the point of sale. Prescription costs are not included in the financing option.
BCBS Coupe PPO includes all the same health resources as the other National Medical Program options except the following: AccessHope cancer support, Health Advocacy Solutions, and Member Rewards.
Use In-Network Providers
Confirm your providers are in-network (and which pricing tier applies to the provider) at healthvalet@coupehealth.com, 1-800-882-5158 or on the Coupe website.
Coupe Health Valets
1-800-882-5158
healthvalet@coupehealth.com
BCBS Coupe PPO Benefits at a Glance
 |
Highest ranking (lowest copay) |
Mid-level ranking (moderate copay) |
Lower ranking (highest copay) |
Out-of-Network2 |
|---|---|---|---|---|
| Annual Deductible | $0 | $0 | $0 | $0 |
| Annual Out-of-Pocket Maximum1 | $8,000 individual/$16,000 family | $8,000 individual/$16,000 family | $8,000 individual/$16,000 family | $8,000 individual/$16,000 family |
| Primary Care Office Visit | $30 | $60 | $145 | $175 |
| Specialist Office Visit | $75 | $150 | $325 | $390 |
| Advanced Imaging MRI, MRA, CAT & PET Scans | $400 | $535 | $910 | $1,090 |
| Routine Diagnostic Labs | $50 | $100 | $150 | $350 |
| Diagnostic Radiology | $205 | $270 | $455 | $545 |
| Diagnostic Labs | $205 | $270 | $455 | $545 |
| Urgent Care | $150 | $150 | $150 | $150 |
| Outpatient Surgery | $1,500 | $1,990 | $3,365 | $4,040 |
- Out-of-network benefits are not subject to the out-of-pocket maximum.
- The calendar year out-of-pocket maximum applies on a per-member per-calendar year basis, subject to the family calendar year out-of-pocket maximum amount. Once a member meets their individual calendar year out-of-pocket maximum, affected benefits for that member will pay at 100% of the allowed amount for the remainder of the calendar year.