PPO tiered networkCommercial PPO tiered network plans
PPO tiered network plans are available for large group (51+) customers. The plans give customers another way to lower costs while providing their employees with access to high-quality, affordable care.
The PPO tiered network is a broad access PPO network with no participating PPO providers excluded. All network PPO hospitals and ambulatory surgical centers (ASCs) were evaluated and assigned to one of two in-network benefit tiers based on cost and minimum quality standards:
- Tier 1 — members pay the lowest cost-sharing for hospital and outpatient surgery services.
- Tier 2 — members pay a higher cost-sharing for hospital and outpatient surgery services when compared to Tier 1.
The following provider types and services are subject to tiering:
- Outpatient surgery at ASCs
- Inpatient hospital admissions for medical and maternity care
- Hospital-based outpatient radiology centers¹
- Hospital-based outpatient labs¹
Frequently asked questions
- Only hospitals within the Independence Blue Cross (Independence) five-county service area (i.e., Philadelphia, Delaware, Montgomery, Bucks, and Chester counties) were assigned benefit tier placements.
- Hospitals within a health system were assigned the same benefit tier to keep member costs the same and reduce confusion.
- Hospital-based outpatient radiology centers and labs are assigned the benefit tier of their affiliated hospital.
- Primary care and specialist office visits
- Emergency room
- Urgent care centers
- Non-hospital-based outpatient labs (LabCorp, independent labs)
- Ambulance providers for emergency and non-emergency ambulance services
- Physical, occupational, and speech therapists
- Injectable medications (included allergy injections)
- Skilled nursing facilities for skilled nursing care
- Home health care
- Durable medical equipment
- Mental health and substance abuse services
¹Benefit tier placements for hospital-based outpatient radiology centers and labs follow their affiliated hospital. These hospital-based outpatient facilities were not evaluated separately from their affiliated acute care hospital.
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