Small Group PPO Providers cont.

PPO Plan Features-

• Seven plans with a wide range of copays and deductibles to fit all healthcare and financial needs
• Two Premier plans with no deductibles and enhanced out-of-network reimbursement
• One Advantage plan with no deductible and graduated out-of-pocket maximum for in-network providers
• Two copay plans with the convenience of fixed office visit copays
• Saver PPO and Basic PPO plans, which are the most affordable options
• Preventive care benefits, including annual HealthyCheck wellness screenings
• Availability of acupuncture and chiropractic benefits

Plan Comparison-

Plans	Basic PPO	Saver PPO	PPO $40 Copay	PPO $30 Copay
Annual Deductible	$1,000 per member	$500 per member	$250 annual deductible for all medical services except office visits	$250 annual deductible for all medical services except office visits
Annual Out-of-Pocket Maximum	Deductible plus $2,000 per member	$5,000 per member	$4,500 per member	$3,500 per member
Office Visits	Not Covered	$20 Copay	$40 copay for initial 12 office visits per member, additional office visits 45% of negotiated fee	$30 copay for initial 12 office visits per member, additional office visits 45% of the negotiated fee
Prescription Drugs	$10 copay generic (for each 30-day supply), $25 copay brand (for each 30-day supply)	$10 copay generic (for each 30-day supply), $25 copay brand (for each 30-day supply)	$15 copay generic (for each 30-day supply), $25 copay brand (for each 30-day supply) after annual $150 brand name prescription drug deductible per member	$15 copay generic (for each 30-day supply), $25 copay brand (for each 30-day supply) after annual $150 brand name prescription drug deductible per member

Plans	Advantage No Deductible PPO $25 Copay	Premier No Deductible PPO $20 Copay	Premier No Deductible PPO $10 Copay
Annual Deductible	None	None	None
Annual Out-of-Pocket Maximum	$3,600 per member, 30% of the negotiated fee up to $900, 10% from $901 to $3,600	$2,500 per member	$2,000 per member
Office Visits	$25 copay for initial 12 office visits per member, additional office visits 45% of the negotiated fee up to $900, 10% from $901 to $3,600	$20 copay for initial 12 office visits per member, additional office visits 40% of the negotiated fee	$10 copay for initial 12 office visits per member, additional office visits 30% of the negotiated fee
Prescription Drugs	$15 copay generic (for each 30-day supply), $25 copay brand (for each 30-day supply)	$10 copay generic (for each 30-day supply), $20 copay brand (for each 30-day supply)	$5 copay generic (for each 30-day supply), $10 copay brand (for each 30-day supply)

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