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Preferred Provider Organization (PPO) FAQs

What is a PPO?
A Preferred Provider Organization (PPO) is a network provider - a doctor, hospital or other health care facility that has entered into a contract to provide medical services or supplies at agreed-upon rates to you or your covered dependents under the plan.
Am I eligible?
  • You are eligible if you are a paid employee of a church, agency or institution affiliated with the Southern Baptist Convention;
    - OR -
  • You are a paid employee of a church, agency or institution with 10 or more employees that shares common religious bonds with the Southern Baptist Convention; and
  • You work 20 or more hours per week; and
  • You provide evidence of good health on yourself and all family members requesting coverage.
If I am declined for coverage, is my family still eligible?

No, under GuideStone Insurance Plans, dependents are only eligible for coverage if the eligible employee, retiree or student also has coverage.  GuideStone does offer a provision for this situation through the Health Limited Plan. If the primary individual is not approved for health coverage, the Health Limited Plan can be offered for that individual, so that approved dependents are still eligible to carry full coverage on one of GuideStone's PPO medical plans.

The Health Limited Plan is a non-underwritten health plan with minimal benefits that is appropriate in certain circumstances.  View the Benefit Summary for an overview of the plan.

In addition to maintaining dependent eligibility, the Health Limited Plan would also be appropriate coverage while underwriting is in progress, so that participants do not experience a break in health coverage. 

What is a copay?
The fixed, up-front dollar amount you pay for certain covered expenses. Office visit copay amounts do not apply toward your deductible or coinsurance, and they do not accumulate toward the out-of-pocket maximum.
What is the difference between “Deductible” and “Family deductible”?
The deductible is the up-front out-of-pocket expense. Participants must meet their deductible with eligible charges before claims will be paid. The family deductible is when family members, together, meet the plan amount determined to be the family deductible.  Then, the plan will consider all family members to have met their deductibles. One individual cannot contribute more than the individual deductible amount toward the family deductible.
What does "Out-of-Pocket Maximum" mean?
The maximum amount for which you are responsible, in addition to applicable deductible, for eligible expenses incurred during the benefit period (generally, in one year).
What is a primary care physician copay?
The amount you pay for an office visit to a network primary care physician such as a pediatrician, general practitioner, family practitioner, internist or gynecologist.
Who is considered a "specialist"?
Any physician not considered a primary care physician. Chiropractic care is paid according to standard plan provisions (number of visits annually are limited).
What wellness and preventive care services are covered on GuideStone’s PPO Plans?
Covered services are based on a preventive health schedule which includes preventive services for children and adults based on recommendations from the U.S. Preventive Service Task Force, the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.  View Preventive Care Schedule (pdf).
Does GuideStone offer COBRA?
No, GuideStone's medical plans are exempt from COBRA, but we do have a provision for continuation of some insurance products depending on the situation.  More information regarding this policy.
Do GuideStone PPO plans cover maternity care?

Yes, all of our PPO plans include maternity coverage.  It does not need to be purchased separately.  New applicants who are expecting a baby will not be excluded because of pregnancy and, if approved for health coverage, the maternity care will be covered according to your plan's benefits.

For participants enrolled in a GuideStone PPO plan, Highmark BCBS also offers an education and support program called Baby BluePrints. This program is designed to help expectant families better understand every stage of pregnancy and make more informed care and lifestyle-related decisions. Enrollment is voluntary. If an expectant mother is interested, she can contact Highmark to enroll at 1-866-918-5267. Program offerings include:
  1. Access to pregnancy-related information on the member site at www.highmarkbcbs.com.
  2. Baby BluePrints enrollment package.
  3. Vouchers for free gifts throughout pregnancy.
  4. Proactive outreach, nurse health coaching and/or case management.
  5. Postpartum depression program.
  6. Reimbursement for childbirth education classes (taken at any location).
How do I locate providers who accept GuideStone's PPO plans?
GuideStone plans utilize the Blue Cross Blue Shield "BlueCard" PPO network.  This is the largest national provider network in America.  In fact, one in three Americans — 88 million people — are covered by BCBS.  BCBS negotiates significant provider discounts for in-network care, resulting in lower out-of-pocket health care expenses for particpants.   BCBS maintains an easy-to-use Web site for fast access to claims, medical information and provider searches: www.bcbs.com.  You may also locate participating doctors and hospitals by calling the BCBS toll-free provider search hotline at 1-800-810-BLUE (1-800-810-2583).
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