SmartSense PPO Health Plans
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Sensible health coverage with smart savings.
If you want reliable, basic protection with some of our lowest monthly rates, a SmartSense health plan could be just what you’re looking for. Each SmartSense plan balances the health coverage you need with the savings you want, along with:
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A choice of annual deductible/monthly rate combinations. Just choose the one that fits your budget.
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One of the largest provider networks in Georgia. With more than 34,000 doctors and 165 hospitals, it’s easy to stay within our network for your health care needs. And our negotiated rates will lower your share of medical costs. |
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Coverage that travels with you. No matter where life takes you, your health coverage goes with you. And providers in our network across the country help make it easy to get the care you need. |
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No referrals or paperwork. You won’t need a referral to see a specialist. And there are no claims or paperwork when you use one of our network providers. |
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Immediate benefits. Each year, each member of your plan will have coverage for their first three in-network doctor visits – and you make the copayments without having to meet your plan’s deductible first.
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Prescription drug savings. Each plan includes coverage for generic drugs with optional coverage available for brand name and specialty prescription drugs. |
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Optional dental and term life insurance. For extra security, you can choose to add one of our popular dental and term life coverage options. |
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Experience you can trust: One of the most trusted names in health coverage, Blue Cross and Blue Shield of Georgia has been providing quality health benefits to state residents for over 70 years.
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SmartSense PPO benefits-at-a-glance
This chart is a brief summary of benefits and is not intended to be a full disclosure of benefits.
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Plan Benefits
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SmartSense
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SmartSense
w/Comprehensive RX
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In-Network
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Out-of-Network
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In-Network
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Out-of-Network
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Calendar Year Deductible Choices
(separate deductibles apply for in-network and out-of-network)
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Individual
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$750
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$1,500
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$2,500
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$750
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$1,500
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$2,500
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$750
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$1,500
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$2,500
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$750
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$1,500
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$2,500
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$5,000
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$10,000
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$20,000
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$5,000
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$10,000
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$20,000
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$5,000
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$10,000
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$20,000
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$5,000
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$10,000
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$20,000
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Family
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$1,500
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$3,000
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$5,000
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$1,500
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$3,000
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$5,000
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$1,500
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$3,000
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$5,000
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$1,500
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$3,000
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$5,000
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$10,000
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$20,000
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$40,000
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$10,000
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$20,000
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$40,000
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$10,000
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$20,000
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$40,000
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$10,000
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$20,000
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$40,000
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Calendar Year
Out-of-Pocket Maximum
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Individual
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Your
deductible
plus $3,000
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Your
deductible
plus $7,500
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Your
deductible
plus $3,000
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Your deductible plus
$7,500
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Family
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Your
deductible
plus $6,000
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Your
deductible
plus
$15,000
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Your
deductible
plus $6,000
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Your deductible plus
$15,000
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Lifetime Maximum
(maximums are combined for in-network and out-of-network)
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Health Plan pays up to $7 Million per member
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Covered Services
These amounts show your share of costs after deductible, if any.
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In-Network
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Out-of-Network
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In-Network
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Out-of-Network
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Doctors’ Office Visits including preventive visits
(Preventive visits for children through age 5 are covered
before the deductible.)
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$30 copay
for the first 3
visits, per
member
per year,
not subject
to
deductible.
After 3
visits, once
deductible
is met, then
30%
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40%
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$30 copay
for the first 3
visits, per
member
per year,
not subject
to
deductible.
After 3
visits, once
deductible
is met, then
30%
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40%
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Child Preventive Services (through age 5)
(Services such as immunizations, laboratory testing.)
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30%
Not subject
to
deductible
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40%
Not subject
to
deductible
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30%
Not subject
to deductible
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40%
Not subject
to
deductible
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Preventive Services (age 6 and over)
(Services such as PSA test, Colorectal screening, mammograms,
pap test, flu shot and colonoscopy.)
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30%
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40%
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30%
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40%
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Professional Services
(x-ray, lab, anesthesia, surgeon, diagnostics, etc.)
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30%
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40%
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30%
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40%
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Hospital Inpatient
(overnight hospital stays)
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Hospital Outpatient
(if you don’t stay overnight)
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Emergency Room Services
(Accidental injury or Medical Emergency as defined by BCBSGa)
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30%
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Maternity
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not covered
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Dental
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Optional coverage available
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Life
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Optional coverage available
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Prescription Drug Coverage
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In-Network
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Out-of-Network
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In-Network
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Out-of-Network
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Generic Prescription Drug Coverage
(see brochure for more information)
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$15 copay (or 40%, whichever is greater)
Not subject to deductible
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Comprehensive
(Specialty and Brand name)
Prescription Drug Coverage
(see brochure for more information)
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Not Covered
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Separate $250 deductible per member per calendar year for brand-name or specialty drugs
$15 copay or 40% (whichever is greater) plus difference in allowable charge if Brand is chosen over an available generic
Out of pocket maximum $300 per prescription and $4,000 per person per calendar year
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