PPO Medical Plan
The PPO medical plan allows you the flexibility of selecting any physician or hospital; however, you will receive a higher level of benefits when using in-network providers.
Under this plan, most office visits and pharmacy are subject to copays while other services – such as hospitalization and diagnostic testing – are subject to deductible and coinsurance, which accrues toward the out-of-pocket maximum. Once the deductible is met, services will be covered at 80%.
The deductibles for individuals and families appear in this table, along with details on coverage benefits.
| Benefits | PPO In-Network Benefits* |
| Deductible | $1,125 Individual / $2,250 Family |
| Coinsurance | You pay 20% Plan pays 80% after deductible is met |
| Out-of-Pocket Maximum (includes medical and pharmacy; deductible, coinsurance, and copays) |
$5,000 Individual / $10,000 Family |
| Office Visits (primary/specialist) |
$30 copay for primary visit $40 copay for specialist visit |
| Preventive Care | Plan pays 100% |
| Physician Services (in-patient and out-patient hospital) |
You pay 20% Plan pays 80% after deductible is met |
| Outpatient Therapy (includes physical, occupational, pulmonary, cognitive, speech and chiropractic) |
You pay $40 copay per visit |
| Emergency Room Visit | You pay $150 copay; then no charge after the deductible is met |
| Urgent Care | You pay $50 copay |
| *Benefits using out-of-network providers may vary. Please refer to the Summary of Benefits and Coverage (SBC) for additional information. | |