|Premium cost (amount deducted from your pay):
|Potential for out-of-pocket costs (deductibles, coinsurance, etc.)
- PPO plan members are not required to choose a PCP, and referrals are not necessary. The PPO provides the highest level of choice.
- Seek care from participating providers and you'll be covered at the in-network benefit level for covered services. Or you can choose to see providers who do not participate with HPHC and be covered at the out-of-network benefit level.
- While the PPO provides more choice, it typically has more out-of-pocket costs both in an out-of-network, with coinsurance and deductibles, as well as paperwork like bills and claim forms.
- In-network coverage: for some services, like doctor's visits, you'll pay a $20 copayment**. Other services, like hospital care, require a $250 individual/$500 family deductible, then you're covered at 90% (you are responsible for remaining 10%)
- Out-of-network coverage: $750 individual/$2,250 family deductible, then 70% or 80% coverage (you are responsible for remaining 20% or 30%)
**The copayment amount is determined by which type of providers you see. A $20 copayment applies to some outpatient services, including most primary care, obstetrical care, gynecological care, mental health care and substance abuse rehabilitation. A $35 copayment applies to most outpatient specialty care. See Schedules of Benefits for details.