Health Insurance

Here’s a brief description of your health plan options:

Premier Preferred Provider Organization
Higher premiums, but lower out-of-pocket costs for your deductible, copays and coinsurance.

Standard PPO
Lower premiums than the Premier PPO, but you’ll pay more out-of-pocket for your deductible, copays and coinsurance.

Consumer-driven Health Plan with a Health Savings Account 
Lowest premiums compared to the other plan options. For most other services outside of in-network preventive care, you pay your deductible first before the plan pays anything, and then you pay coinsurance, not copays. Go to the CDHP/HSA page to learn more.

Find the 2027 benefit comparison for state and higher education

Find the 2026 benefit comparison for state and higher education

Local education and local government employees: Health plan options are changing for 2027, and a new Copay Preferred Provider Organization will be offered. Members who select the Copay PPO for 2027 will use BlueCross BlueShield Network S providers only. Please review your options carefully.  

Here’s a brief description of your health plan options: 

Premier Preferred Provider Organization
Higher premiums, but lower out-of-pocket costs for your deductible, copays and coinsurance.

Standard PPO
Lower premiums than the Premier PPO, but you’ll pay more out of pocket for your deductible, copays and coinsurance.

Limited PPO
Lower premiums than the Standard PPO, but you’ll pay more out of pocket for your deductible, copays and coinsurance compared to the other PPOs.

Copay PPO
Lowest premiums compared to the other plan options. You’ll pay simple, predictable copay costs so you’ll know what care will cost ahead of time. There is no deductible with this plan. Go to the Copay PPO section for more details, and you can watch a video to learn more.

Local Consumer-driven Health Plan with a Health Savings Account
Lower premiums than the Limited PPO. For most other services outside of in-network preventive care, you pay your deductible first before the plan pays anything, and then you pay coinsurance, not copays. Go to the CDHP/HSA page to learn more.

Find the 2027 benefit comparison for local education and local government.

Find the 2026 benefit comparison for local education and local government.

With the Copay PPO, members pay simple, predictable copay costs, so they’ll know what care will cost ahead of time. There is no deductible with this plan. Watch this video to learn more.

• The Copay PPO has the lowest monthly premiums compared to the other plan options.
• Copay PPO members will use only BlueCross BlueShield Network S providers. These providers will be in two different tiers, Tier 1 and Tier 2. Members will pay less when they choose providers in Tier 1. Search the BCBST Tiered Network S directory for your providers and learn if they are in Tier 1 or Tier 2.
• Copay PPO behavioral health and substance use services are covered and administered by Optum Behavioral Health.
• With the Copay PPO, there are out-of-pocket maximums to protect members from high costs.

Find the 2027 benefits comparison for local education and local government

Copay PPO - Pharmacy Benefits
Copay PPO members will use the CVS Value Formulary. This formulary is more selective in the medications it covers and only includes two tiers:

• Generic medications, and
• Most preferred brand-name medications

Copay PPO members pay copays for generic and brand-name prescriptions. The copay also depends on the number of days’ supply you receive. 

Specialty Drugs
Members pay 30% coinsurance for specialty medications, which are limited to a 30-day supply for each fill. Additionally, there is a separate maximum out-of-pocket for specialty drugs processed through the pharmacy benefit. This amount varies based on your coverage tier.

Weight-loss Medications
Members pay 25% coinsurance for weight-loss medications and are limited to a 30-day supply for each fill.

Visit the Pharmacy webpage to see which medications are covered. Here you’ll find the CVS Value Formulary for Copay PPO members no later than Oct. 1. This formulary is updated quarterly.