PPO Medical Plan

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
$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.
Your Rights

This website highlights some of your benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. The company reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.

City of Baytown Human Resources

(281) 420-6520