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.
  • 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.

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 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.

 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).