Premium PPO Plan

 

• Deductibles: The Premium PPO plan has a $450 per individual deductible and a $900 per family deductible. The combination of deductible expenses for the entire family will not exceed $900.
  
  
• Coinsurance: Once you have met the deductible, the plan will pay at 80 % of covered expenses from in-network providers or 60% of covered expenses from out-of-network providers.
  
  
• Annual Out-of-Pocket Maximums: Your annual out-of-pocket maximum, including deductible, is $1,800 in-network/$2,200 out-of-network for individual and $3,600 in-network/$4,400 out-of-network for employee + spouse, employee + child(ren) and family coverage.
  
  
• In-Network Office Visit Coinsurance: You will pay 35% of an office visit charge. The 35% coinsurance for office visits does not count toward the deductible nor out-of-pocket maximum requirements. Out-of-network office visit charges are paid at 60% after deductible and coinsurance are satisfied.
  
  
• Prescription Drug Coverage (administered by CVS Caremark): Prescription drugs are not subject to your deductible or coinsurance. Instead, you have a copayment for each prescription. Prescription drug copayments do not count toward your deductible or annual out-of-pocket maximum.

Cost of Premium PPO Plan

Full-Time Monthly Medical Plan Rates (Employees Working 32+ Hours)
Coverage Tiers	Employee Cost
Employee Only	$120
Employee + Spouse/Domestic Partner	$294
Employee + Child(ren)	$270
Family	$446

 

What medical plan is right for you?  Use the customized Health Plan Cost Estimator Tool.

 

Deductibles for Premium PPO Plan

The deductibles that apply to you depend on the coverage level you selected and are applied to eligible services rendered each calendar year. The deductibles under the PPO Plans start over each Jan. 1.

Coverage for an Individual

• If you elect coverage for yourself, the individual deductible applies to you. You must pay for covered medical services for yourself. 
  
  
• The plan will not begin to pay for benefits until you meet the individual deductible.

Coverage for an Individual and One or More Dependents

• If you elect coverage for yourself and one or more eligible dependents, a family deductible applies to all as a single-family unit.
  
  
• You must pay for covered medical services until any combination of two or more members of your family meet the family deductible. 
  
  
• If, however, you pay for covered medical services for any covered member of your family and meet an individual deductible, the plan will start paying for benefits for that covered family member. 
  
  
• The individual deductible helps to limit what you have to pay if one person in the family uses more health care than the rest of the family. 
  
  
• Any one or more of the other covered members of your family can then meet the rest of the family deductible.  After that, the plan will pay for benefits for the rest of the family members.