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.<\/p>\n
Under this plan, most office visits and pharmacy are subject to copays while other services \u2013 such as hospitalization and diagnostic testing \u2013 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%.<\/p>\n
The deductibles for individuals and families appear in this table, along with details on coverage benefits.<\/p>\n
| Benefits<\/b><\/td>\n | PPO In-Network Benefits*<\/strong><\/td>\n<\/tr>\n| Deductible<\/b><\/td>\n | $1,125 Individual \/ $2,250 Family<\/td>\n<\/tr>\n | Coinsurance<\/b><\/td>\n | You pay 20% | \nPlan pays 80% after deductible is met<\/td>\n<\/tr>\n Out-of-Pocket Maximum<\/b> | \n(includes medical and \npharmacy; deductible, coinsurance, and copays)<\/td>\n $5,000 Individual \/ $10,000 Family<\/td>\n<\/tr>\n | Office Visits<\/b> | \n(primary\/specialist)<\/td>\n $30 copay for primary visit | \n$40 copay for specialist visit<\/td>\n<\/tr>\n Preventive Care<\/b><\/b><\/td>\n | Plan pays 100%<\/td>\n<\/tr>\n | Physician Services<\/b> | \n(in-patient and out-patient hospital)<\/td>\n You pay 20% | \nPlan pays 80% after deductible is met<\/td>\n<\/tr>\n Outpatient Therapy<\/b> | \n(includes physical, occupational, \npulmonary, cognitive, speech and chiropractic)<\/td>\n You pay $40 copay per visit<\/td>\n<\/tr>\n | Emergency Room Visit<\/b><\/td>\n | You pay $150 copay; | \nthen no charge after the deductible is met<\/td>\n<\/tr>\n Urgent Care<\/b><\/td>\n | You pay $50 copay<\/td>\n<\/tr>\n | *Benefits using out-of-network providers may vary. Please refer to the Summary of Benefits and Coverage (SBC) for additional information.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n","protected":false},"excerpt":{"rendered":" | 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 \u2013 such as hospitalization and diagnostic testing \u2013 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… Continue Reading PPO Medical Plan<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3689","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/pages\/3689","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/comments?post=3689"}],"version-history":[{"count":0,"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/pages\/3689\/revisions"}],"wp:attachment":[{"href":"https:\/\/baytownbenefits.com\/index.php\/wp-json\/wp\/v2\/media?parent=3689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |