PPO Plan - My ACI Benefits

With the PPO Plan , you can see both in-network and out-of-network providers without a referral, but keep in mind staying in-network for care will almost always be less expensive.

Access the 2026 PPO Medical Plan Everyday Guide

2026 PPO Plan
Where Available	Nationwide Find BCI providers in your area.
Annual Deductible - Associate - Family	Embedded $1,300 $2,600
Annual Out-of-Pocket Max - Associate - Family	Embedded $4,700 $9,400
	IN-NETWORK - YOU PAY
Preventive Care	$0²
Teladoc Telemedicine Visit - Medical - Mental Health	$20 per visit $20 per visit
Office Visit - PCP - Specialist	20%¹ 20%¹
Urgent Care	20%¹
Emergency Room	20%¹
Diagnostic Testing	20%¹
Outpatient X-Ray and Lab	20%¹
Hospitalization - Inpatient Semi-Private Room - Inpatient Physician	20%¹ 20%¹
Outpatient Treatment (Physical, Occupational & Speech Therapy)	20%¹
Mental Health/Substance Abuse - Inpatient - Outpatient	20%¹ 20%¹
Pharmacy Retail	30-day supply
- Annual Deductible Applies - Pharmacy Out-of-Pocket Max	No Combined with medical
- ACA Preventive Drugs on Essential Drug List - Generic - Brand Preferred - Brand Non-Preferred	$0 copay (no deductible) $10 copay 25%² (min $35, max $105) 35%² (min $70, max $140)
Pharmacy Retail/Mail Order	90-day supply
- ACA Preventive Drugs on Essential Drug List - Generic - Brand Preferred - Brand Non-Preferred	$0 copay (no deductible) $30 copay 25%² (min $105, max $315) 35%² (min $210, max $420)

1) Coinsurance you pay after you meet the annual deductible unless otherwise noted.
2) Annual deductible waived.