BCBS Coupe PPO

Your National Medical Program options include BCBS Coupe PPO.

February 24, 2026

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.
  • 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.

BCBS Coupe PPO also includes optional health care financing. BCBS Coupe PPO participants have the option to receive a health care financing card from Paytient. If you elect health care financing, your Paytient card will have a $3,000 revolving credit limit to pay your medical bills over time with 0% financing.

You must actively enroll and request financing through the enrollment website to get access to the special Paytient financing for BCBS Coupe PPO participants.

You cannot sign up for Paytient financing after enrollment ends.

 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, Maven, 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.

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
Emergency Room/Emergency Services
$1,200
$1,200
$1,200
$1,200
Ambulance
$1,200
$1,200
$1,200
$1,200
Outpatient Therapies PT, OT & ST
$50
$100
$150
$250
Inpatient Hospital Stay
$4,400
$5,800
$8,000
$11,000
Home Health Care
$115
$155
$260
$315
Hospice
$460
$615
$1,035
$1,245
Skilled Nursing Facility
$4,400
$4,895
$8,000
$10,560
Durable Medical Equipment
$230
$310
$520
$625

Highest ranking(lowest copay)
Annual Deductible$0
Annual Out-of-Pocket Maximum$8,000 individual/$16,000 family
Primary Care Office Visit$30
Specialist Office Visit$75
Advanced Imaging MRI, MRA, CAT & PET Scans$400
Routine Diagnostic Labs$50
Diagnostic Radiology$205
Diagnostic Labs$205
Urgent Care$150
Outpatient Surgery$1,500
Emergency Room/Emergency Services$1,200
Ambulance$1,200
Outpatient Therapies PT, OT & ST$50
Inpatient Hospital Stay$4,400
Home Health Care$115
Hospice$460
Skilled Nursing Facility$4,400
Durable Medical Equipment$230

Mid-level ranking(moderate copay)
Annual Deductible$0
Annual Out-of-Pocket Maximum$8,000 individual/$16,000 family
Primary Care Office Visit$60
Specialist Office Visit$150
Advanced Imaging MRI, MRA, CAT & PET Scans$535
Routine Diagnostic Labs$100
Diagnostic Radiology$270
Diagnostic Labs$270
Urgent Care$150
Outpatient Surgery$1,990
Emergency Room/Emergency Services$1,200
Ambulance$1,200
Outpatient Therapies PT, OT & ST$100
Inpatient Hospital Stay$5,800
Home Health Care$155
Hospice$615
Skilled Nursing Facility$4,895
Durable Medical Equipment$310

Lower ranking(highest copay)
Annual Deductible$0
Annual Out-of-Pocket Maximum$8,000 individual/$16,000 family
Primary Care Office Visit$145
Specialist Office Visit$325
Advanced Imaging MRI, MRA, CAT & PET Scans$910
Routine Diagnostic Labs$150
Diagnostic Radiology$455
Diagnostic Labs$455
Urgent Care$150
Outpatient Surgery$3,365
Emergency Room/Emergency Services$1,200
Ambulance$1,200
Outpatient Therapies PT, OT & ST$150
Inpatient Hospital Stay$8,000
Home Health Care$260
Hospice$1,035
Skilled Nursing Facility$8,000
Durable Medical Equipment$520

Out-of-Network2
Annual Deductible$0
Annual Out-of-Pocket Maximum$8,000 individual/$16,000 family
Primary Care Office Visit$175
Specialist Office Visit$390
Advanced Imaging MRI, MRA, CAT & PET Scans$1,090
Routine Diagnostic Labs$350
Diagnostic Radiology$545
Diagnostic Labs$545
Urgent Care$150
Outpatient Surgery$4,040
Emergency Room/Emergency Services$1,200
Ambulance$1,200
Outpatient Therapies PT, OT & ST$250
Inpatient Hospital Stay$11,000
Home Health Care$315
Hospice$1,245
Skilled Nursing Facility$10,560
Durable Medical Equipment$625

  1. Out-of-network benefits are not subject to the out-of-pocket maximum.
  2. 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.