Harvard Pilgrim Health care Home

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Member > John Hancock > Health Plan Options > ChoiceNet PPO
ChoiceNet PPO

Premium cost (amount deducted from pay) Medium
Potential for out-of-pocket costs (deductibles, coinsurance, copayments) Low to Mid-range

  • PPO plans offer extensive choice — receive care from virtually any doctor or hospital without referrals.

  • Most routine preventive tests and screenings are covered in full when received from participating providers.

  • Harvard Pilgrim places physicians and hospitals into one of three tiers based on cost and quality performance. You will pay different cost-sharing based on a provider’s assigned benefit tier.

  • Your cost-sharing amount depends on the tier of the provider who cares for you. Here’s an example: for in-network care, you have individual deductibles of $500 for Tier 1, $1,000 for Tier 2 and $2,000 for Tier 3. You also have family deductibles of $1,000 for Tier 1, $2,000 for Tier 2 and $4,000 for Tier 3.

  • You’ll also pay different copayment levels for PCP/specialists*, which also vary depending on the tier of the provider: $20/$35 for Tier 1 PCPs/Specialists, $30/$50 for Tier 2 and $40/$65 for Tier 3.

  • If you see providers who aren’t medical doctors, such as chiropractors or optometrists, you’ll pay the lowest copayment level since they’re automatically placed into Tier 1.like x-rays, blood work and hospital care.

  • You have “in-network” benefits when you receive care from thousands of doctors and clinicians who participate and “out-of-network” benefits when you receive care from those who do not. For details on your out-of network coverage, please see your Schedule of Benefits.

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2017 Tiered Hospitals*

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Schedule of Benefits*

Prescription Drug Coverage