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.
PPO
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.
- 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 of $1,000.00 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 of $1,000.00
- If four or more people are covered, any combination of family members can reach the family deductible of $3,000.00. No one member will go above the single deductible of $1,000.00 before the health plan starts to pay.
- Prescription drugs don't count toward the deductible.
- The plan pays 80 percent of most services once the deductible is reached.
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 of $2,000.00 must be met.
- If two or more people are covered, the family deductible of $4,000.00 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 toward 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.