Health Benefits - 9 - Medical PPO

Health Benefits - 9 - Medical PPO

The Preferred Provider Organization Plan (PPO) is available with CareFirst BlueCross Blue Shield or United Healthcare.  Each plan provides a national network and neither have a primary care physician requirement.  The PPO provides both in-network and out-of-network benefits. For in-network major medical services, the plan pays 90% of the allowed benefit with a patient responsibility of 10% as a co-insurance.  A co-pay applies to in-network Primary Care and Specialist visits.  Co-insurance will apply to out-of-network office visits.  Many in-network preventive care services are not subject to a co-pay.  There will be either a co-pay or co-insurance for services, not both.  Out-of-network options are also available with the plan paying 70% of the allowed benefit after a deductible.  The patient's co-insurance responsibility is 30%, plus any amount not covered under the allowed benefit.  Out-of-network means the physician's office or medical facility is not contracted with the insurance company.  In-network services will not be subject to a deductible; however, out-of-network services will be subject to a deductible of $250 for Individual or $500 for family coverage.  Refer to the Benefits Guide for a list of services that are not subject to a co-pay.

updated 02/02/2016