Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If a preferred provider is not used, coinsurance will be reduced to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare and subject to the single and family deductibles and out-of-pocket maximums listed in Appendix D. Any network modifications made by the plan administrator will apply. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If the participating providers are not used, coinsurance reduces to sixty/forty percent (60/40%). The additional twenty percent (20%) coinsurance is the employee's responsibility and not subject to the out-of-pocket maximum. Any PPO network modifications by the Plan Administrator will apply. Effective January 1, 2018, if a preferred provider is not used, coinsurance will be reduced to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare and subject to the single and family deductibles and out-of-pocket maximums listed in Appendix D. Any network modifications made by the plan administrator will apply.
Medical PPO. Covered Services In Network-tier 1 In Network- tier 2 Out of Network -tier 3 Deductible Out of Pocket Maximum Specialized imaging procedures such as CT/CAT scans, MRI and PET Diagnostic Laboratory
Medical PPO. Covered Services In Network-tier 1 In Network- tier 2 Out of Network -tier 3 Deductible Individual $300 $350 •1,500 Family $900 $1,050 $4,500 Out of Pocket Maximum Individual $1,000 $1,500 $3,500 Family $2,000 $3,000 $7,000 Preventive Care Visits and Health Screenings Covered at 100% Covered at 100% Not covered Office visits - non preventive office visits $20 primary care$30 specialist $25 primary care$35 specialist 40% of PP0 allowed rate after the deductible plusbalance of bill Annual Deductible must be paid before Plan covers these services: YOU PAYAfter Tier 1 deductible YOU PAYAfter Tier 2 deductible YOU PAYAfter Out of Network Deductible Specialized imaging procedures such as CT/CAT scans, MRI and PET Provided in a hospital setting 10% 25% 0% PP0 allowed rate plus balance Provided in a free-standing imaging center 0- 0- 0% PP0 allowed rate plus balance Diagnostic Laboratory
Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If the participating providers are not used, coinsurance reduces to sixty/forty percent (60/40%). The additional twenty percent (20%) coinsurance is the employee's responsibility and not subject to the out-of-pocket maximum. Any PPO network modifications by the Plan Administrator will apply.
