Health Investor PPO
Like the State Employees' Standard PPO Plan, the Health Investor PPO gives you flexibility to see network or non-network providers, with a significantly lower cost to you when you use network providers. If you are Medicare-eligible, the Health Investor PPO provides secondary coverage - paying benefits after Medicare pays (or would have paid) it's benefits. Here are the highlights of how the plan works.
|
Health Investor PPO | ||
|---|---|---|
| Covers Care Received | Network or Non-network | |
| You Meet Annual Deductible | Network | Non-Network |
| Individual Coverage | $1,250 | $2,500 |
| Family Coverage | $2,500 | $5,000 |
| With family coverage, you must meet the family deductible before anything but preventive care is covered | ||
| What You Pay For Care Received After Deductible | 20% of Network Allowed Amount | 40% of Non-network Allowance |
| - Medical Care | ||
| - Prescription Drug | ||
| -o- Generic and Preferred Brand | 30% | Pay in Full and File a Claim |
| -o- Non-preferred brand | 50% | Pay in Full and File a Claim |
| Annual out-of-pocket maximum (after deductible) | ||
| - Individual | $3,000 | $7,500 |
| - Family | $6,000 | $15,000 |
| After your out-of-pocket coinsurance costs reach these maximums, for the rest of the calendar year the plan pays 100% for covered care in most cases, up to allowable costs | ||
| Preventive care: routine physical exams, health screenings and immunizations | 100% of allowed amount; see preventive care | 100% Allowance |
While BlueCross BlueShield of Florida/Caremark administer both PPOs - and while both PPOs cover the same medical services and supplies - there are some key ways the Health Investor PPO is different. With the Health Investor PPO:
- If you contribute toward the cost of your coverage, your monthly insurance premiums are lower
- If you or your covered dependents do not have other medical coverage*, you may open a Health Savings Account and make pre-tax contributions to it. You can use the HSA to pay out-of-pocket expenses like your deductible and coinsurance - now or in the future.
- For specific preventive care services, there's no deductible.
- Except for preventive care, you must meet the deductible before benefits begin for medical care or prescription drugs.
- If you have family coverage, you and your dependents must meet the family deductible before the plan pays benefits for any of you as individuals. If you have an HSA, you can use available funds for eligible expenses while you're meeting the deductible.
*For purposes of determining whether you may open a Health Savings Account, "other coverage" includes coverage through your spouse's employer's plan, Medicare, Medicaid, a Healthcare Flexible Spending Account that covers medical expenses (like the State's Medical Reimbursement Account), or any other medical plan.