Advantage PPO Health Plan

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Basic Definition Higher payroll deduction, and generally co-pay and out-of-pocket expenses are lower
Calendar Year Deductible

In Network / Out of Network

$1,000 per person each calendar year; $3,000 family maximum

Calendar Year Out-of-Pocket Maximum

(This is the amount you would pay before benefits would be paid at 100%.)

In Network / Out of Network

Separate Medical: $2,000 individual; $6,000 family (Includes $1,000 individual; $3,000 family medical deductible). Separate Prescription Drugs: $3,300 individual; $6,600 family (Includes $150 individual; $450 prescription drug deductible)

In-Network: Deductibles, Co-pays and Coinsurance apply to the out-of- pocket maximum

Out of Network: Coinsurance applies to the out-of-pocket maximum

Preventive Care

(See the Preventive Services Listing for details.)

In Network
100 percent coverage for all listed services

Out of Network
Not covered

Office Visit

In Network
100 percent coverage after $35 Primary Care physician co-pay (ob/gyn included); 100% coverage after $60 specialist co-pay

Out of Network
70 percent coverage (MAC*) after annual deductible

Hospital Visit

In Network
90 percent coverage after $300 per-admission co-pay

Out of Network
70 percent MAC coverage after $300 per-admission co-pay

Emergency Services

In Network
90 percent coverage after calendar year deductible

Out of Network
90 percent MAC coverage after calendar year deductible

Chiropractic Care

In Network / Out of Network
90 percent coverage after calendar year deductible; limit of 30 total visits per person per calendar year

Speech, Physical and Occupational (hand) Therapy

In Network / Out of Network
90 percent coverage subject to calendar year deductible; limit of 40 habilitative and 40 rehabilitative visits per person per calendar year. Medical necessity review required for visits 20-40

PET Scans, CT Scans, MRI and MRA's

In Network / Out of Network
Precertification required for these screenings. No coverage for non-certified procedures.

In Network
Covered at 90% of the allowance with no deductible or copay.

Out of Network
Covered at 70% of the allowance subject to the calendar year deductible

Need Help?

Contact the HR Connect Team at 1-877-562-8383

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