Hi,

I just started a new job and chose the PPO option for my insurance. I want to make sure I am interpreting it correctly and would like to know if it provides good coverage (I am dumb about the health system/insurance).

It is a BCBS PPO with tiered benefits and I am single, so it’s just me. Tier 1 is the best and then is goes down from there for the next two tiers, the third tier is out of network. I want to make sure I understand the tiers. Plan details:

Premium: I pay $68 biweekly, my employer covers the rest ($1,768/annually for me)

Tier 1:

Deductible: $500

OOP Max: $2,500

PCP/Specialist Copays: $20/$40

Co-insurance: 90/10

Tier 2:

Deductible: $1,000

OOP Max: $3,000

PCP/Specialist Copays: $30/$60

Co-insurance: 70/30

Tier 3 (Out of network):

Deductible: $2,000

OOP Max: $9,000

PCP/Specialists: 40% co-insurance

Co-insurance: 60/40

So, the way I am interpreting it is, say I keep all of my care in the first tier by using tier 1 providers exclusively (there are actually a lot of providers in the tier 1), the maximum I would have to spend in a year with the cost of the premium out of my paycheck is $4,268. For tier 2, $4,768, and for tier 3, $10,768, is that correct? Would this be considered average/good coverage?

TIA

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