With the PPO plan, you get free preventive care and pay copays for visits to in-network doctor’s offices (excluding specialists), some urgent care clinics and emergency rooms. You also pay copays or coinsurance for prescription drugs. For other care, you meet a deductible and then pay 20% coinsurance until you meet your out-of-pocket maximum.
Each person has an individual $1,500 in-network deductible. When a family member has spent the individual deductible amount, they begin to pay coinsurance for in-network services. Meanwhile, if other family members need care, they must meet their individual deductibles unless the family deductible of $4,500 has been met (for a family with three or more members). Your copays for office visits, urgent care clinics, Telehealth and prescription drugs do not count toward your deductible. In-network services do not apply to your out-of-network deductible and out-of-network services do not apply toward your in-network deductible.
*In-network and out-of-network deductibles are separate. Only in-network services apply toward your in-network deductible, and only out-of-network services apply to your out-of-network deductible.
**If you (as a plan participant) receive a brand name drug in place of a generic in either of the situations below, the plan will only cover the cost of the generic drug, requiring you to pay the cost difference between the generic drug and the brand name drug: