Comparing Your Choices

PPO vs. HDHP: Highlights and Deductibles

No matter which plan you choose, both include these features:

  • No-cost preventive care, including annual physicals, immunizations, mammograms and more
  • Free flu vaccinations for team members and covered dependents
  • 20 percent coinsurance on most medical services after deductible is met
  • In-network providers based on your home zip code
  • Coverage on prescription drugs
  • A significant portion of the premium covered by Carle Health

Low-deductible copay plan

Plan Highlights

  • Lower, embedded deductible and out-of-pocket maximum
  • Copays for office and Emergency Department visits
  • Copays for outpatient lab and radiology diagnostic services (new for 2023).
  • In-network office visits are covered in full after you pay a low copayment. There's no deductible or coinsurance unless your doctor performs a procedure or orders services such as lab or X-ray.
  • Opportunity to sign up for a Flexible Spending Account (FSA) to help pay using pre-tax dollars for expenses not covered by the plan

How an Embedded Deductible Works

  • If there's only one person on the plan, the single deductible must be met before the health plan starts to pay.
  • If either two or three people are covered, each covered person must meet the single deductible.
  • If four or more people are covered, any combination of family members can reach the family deductible. No one member will go above the single deductible before the health plan starts to pay.
  • Prescription drugs don't count towards the deductible.
  • The plan pays 80 percent of most services once the deductible is reached.

High deductible coinsurance plan with Health Savings Account

Plan Highlights

  • Lower premium with higher, aggregate deductible and out-of-pocket maximum
  • No copays for office visits or Emergency Department visits. Everything you pay for medical services and prescription drugs applies towards meeting your deductible.
  • Take advantage of triple tax savings through the use of a Health Savings Account (HSA). Contributions (up to IRS limit), earnings and withdrawals (for qualified expenses) are all tax-free.

How an Aggregate Deductible Works

  • With only one person on the plan, the single deductible must be met.
  • If two or more people are covered, the family deductible can be met by one person or a combination of family members. One covered person could reach the full deductible for the family.
  • Prescription drugs count towards the deductible; you pay the full cost of prescriptions until the deductible is met.
  • Plan pays 80 percent of most services once the deductible is reached.

 Good to Know

Covered Preventive Care

Both plans cover at no cost:

  • One wellness exam per member (no age limitations) per plan year including a Women's Principal Health Care Provider
  • Well-child care including immunizations
  • Cervical cancer vaccine 
  • Screenings including:
    • blood sugar
    • cholesterol
    • cervical cancer screening (Pap smear)
    • sexually transmitted disease
    • Colorectal cancer (flexible sigmoidoscopy, screening colonoscopy, fecal occult blood test)