Advantage PPO Health Plan

In Network / Out of Network

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

(See the Preventive Services Listing for details.)

In Network
100 percent coverage for all listed services

Out of Network
Not covered

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

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

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

In Network
90 percent coverage after calendar year deductible

Out of Network
90 percent MAC coverage after calendar year deductible

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

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

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