Medical

Preferred Provider Organization (PPO)

Genesee Area Healthcare Plan is a Preferred Provider Organization or PPO. They are called “preferred provider organizations” because the insurer (Excellus BCBS Rochester Region) prefers that the subscriber use certain providers. The subscriber is encouraged to use the in-network or “preferred” providers with whom the insurer has cost saving agreements in place.

There are no restrictions as to what doctors are available to the subscriber, however, PPO’s offer the subscriber financial incentives to use in-network health care providers. When you choose an out-of-network provider, you first have to meet an annual individual or family deductible and then you are responsible for a coinsurance (a percentage of the cost of services). Remember that there are PPO participating provider networks throughout the United States available to you. Excellus BlueCross BlueShield of Rochester has partnerships with other BlueCross BlueShield Plans around the country to see that subscribers and their families, living or traveling outside the Rochester area can take advantage of their in-network benefit. If you are out of town and get sick, or if you or a family member live outside the Rochester region and need to find an in-network provider, simply call the BlueCard PPO Network Doctor and Hospital Information Line at 1-800-810-2583 or to check the online portal click HERE.

Important: Plan Changes Effective January 1, 2027

PPO and PPO-D2 COPAYMENT CHANGES:

Beginning January 1, 2027, the third phase of copayment changes will be implemented for both the PPO and PPO-D2 plans.

For the PPO changes click HERE and for the PPO-D2 changes click HERE.

COPAYMENT CHANGES FOR THE OVER 65 PPO PLAN:

Starting January 1, 2027, the Over 65 PPO Plan will expand copayments to include all office visits and inpatient hospital stays. Current copayments such as Emergency room, Ambulance and Telemedicine will remain the same.

Over 65 PPO Plan Expanded Copayments:

Primary Care Physician (PCP)……………………$30.00
Specialist**………………………………………….$35.00
Urgent Care………………………………………….$35.00
Inpatient Hospital (per stay)……………………..$100.00

**Specialists include services such as Chiropractic, Physical, Occupational, and Speech Therapy, and Outpatient Mental Health Services.