- A network that is divided into 2 tiers of in-network doctors and hospitals
- Tier 1 is the largest network of doctors and hospitals in our 13-country service area. It includes expanded in-network coverage with doctors and hospitals located just outside our 13-county service area. And you’ll pay the lowest out-of-pocket costs for care
- Tier 2 includes local doctors, hospitals and facilities that charge a “facility fee” which means you’ll pay more for care
- The freedom to see BlueCard® PPO national network doctors and hospitals or other out-of-network doctors and hospitals, but you will pay more for care
- No out-of-pocket costs for preventive care
- Exclusive wellness discounts on fitness classes, nutrition counseling, massages, restaurants and more
- Access to your own personal health coach and 24/7 access to registered nurses—so you’ll have the support you need to stay healthy, anytime
Below are links to resources to help you understand your health insurance plan. Be sure to bookmark this page and refer to it often. More information is also available on Self-Service—logon today.
| Member Handbook Kit✝
Your Member Handbook kit makes your health insurance plan easier to understand and use. It explains what’s covered and how to get care. | Learn More
|| Rx Drug Benefits
If your employer offers prescription drug coverage through BCNEPA, your plan may have either the multi-tiered or coinsurance program. These programs help keep your drugs affordable because they use a
formulary. | Learn More
Need more information? Email Customer Service through Self-Service or give us a call at 1.888.345.2346 or (TTY) 1.866.280.0486, weekdays, between 8 a.m. and 5 p.m.
*If your plan is self-insured, be sure to read this version of Your Blue Book to see how Blue Cross of Northeastern Pennsylvania works with your plan sponsor for the best coverage and benefits. Check with your employer or plan administrator to see if you have a self-insured plan.
✝Policies and provisions described in the documents referenced here may not apply to all self-insured group plans.
AffordaBlue uses the Tiered Custom PPO network. The Tiered Custom PPO network divides in-network providers into 2 tiers.
Your cost for care is the lowest when you use in-network/tier 1 doctors and hospitals. Tier 1 includes the First Priority Life® PPO network providers and care from Blue Distinction Centers for Transplants® and several hospitals and their participating doctors, located just beyond our 13-county service area.
This network includes a 2nd tier to cover care from local doctors, hospitals and providers that charge a “facility fee.” You will pay more out of your pocket when you use in-network/tier 2 doctors and hospitals.
BlueCard PPO doctors and hospitals are out of the network with your Tiered Custom PPO plan. You can use BlueCard PPO providers, but at a higher out-of-pocket cost for care.
You have coverage for care outside of the Tiered Custom PPO network, but at a higher out-of-pocket cost. Doctors and hospitals out of the Tiered Custom PPO and BlueCard PPO networks do not accept our discounted “allowable charge” as payment in full. They may bill you for a bigger share of the cost for your care.
Get more information: