Blue Cross Blue Shield PPO Rates and Benefits

2014 Blue Cross Blue Shield Service Benefit Plan Rates

Basic Option

Rate-PlanSelf (111)Self and family (112)
Non-postal bi-weekly$60.96$142.75
Non-postal monthly$132.09$309.30
Postal bi-weekly (Category 1)$40.24$94.22
Postal bi-weekly (Category 2)$53.04$124.20

Standard Option
Rate-PlanSelf (104)Self and family (105)
Non-postal bi-weekly$87.82$204.98
Non-postal monthly$190.28$444.12
Postal bi-weekly (Category 1)$65.96$156.36
Postal bi-weekly (Category 2)$79.62$186.75

To view a table that gives a brief overview of the BCBS Service Benefit Plan PPO Benefits, including what you'll pay for various services, access the Service Benefit Plan Comparison of Benefits guide (PDF, 1.4MB). Please refer to the BCBS Service Benefit Plan Contract Brochure RI 71-005 (PDF, 1.2MB) for detailed terms and conditions of coverage, including plan limitations and exclusions.

2014 BCBS Service Benefit Plan (PPO) Contract Brochure RI-005 (PDF, 1.2MB)
2014 BCBS Standard and Basic Option Service Benefit Plan Summary Guide (PDF, 6.3MB)

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