Blue Cross Blue Shield PPO Rates and Benefits

2016 Blue Cross Blue Shield Service Benefit Plan Rates

Basic Option

Rate PlanSelf (111)Self + One (113)Self and family (112)
Non-postal bi-weekly$68.48$160.75$164.20
Non-postal monthly148.38  348.29  355.76
Postal bi-weekly (Category 1)  56.84  135.14  137.06
Postal bi-weekly (Category 2)  68.48  160.75  164.20

Standard Option
Rate PlanSelf (104)Self + One (106)Self and family (105)
Non-postal bi-weekly$100.18$231.31$238.24
Non-postal monthly  217.06  501.17  516.18
Postal bi-weekly (Category 1)    88.32  205.70  211.10
Postal bi-weekly (Category 2)  100.18  231.31  238.24

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, 230 KB). Please refer to the BCBS Service Benefit Plan Contract Brochure RI 71-005 (PDF, 2.13MB) for detailed terms and conditions of coverage, including plan limitations and exclusions.

2016 BCBS Service Benefit Plan (PPO) Contract Brochure RI-005 (PDF, 2.1MB)
2016 BCBS Standard and Basic Option Service Benefit Plan Summary Guide (PDF, 6.9MB)

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