MEDICAL PLAN SELECTION. PPO and HMO Network Plans: Select PPO and Select HMO Network Plans: PPO 10/0/10% PPO 20/500/20% PPO HRA 45/5000/10% Select PPO 10/0/10% Select PPO 20/500/20% Select PPO 25/500/30% Select PPO 25/500/30% RxV Select PPO 35/1000/40% Select PPO 40/1800/40% Select PPO 40/1800/40% RxV Select PPO 45/1500/50% Select PPO 45/5000/10% Saver Select PPO HRA 45/5000/10% PPO HSA 1350/50% PPO HSA 1750/30%RxC PPO HSA 2700/20%/RxC PPO HSA 3500/30%/RxC PPO HSA 4500/20%/RxC PPO HSA 5500/0%/RxC HMO 10/0% HMO 35/20% Select PPO HSA 1350/50% Select PPO HSA 1750/30%/RxC Select PPO HSA 2700/20%/RxC Select PPO HSA 3500/30%/RxC Select PPO HSA 4500/20%/RxC Select PPO HSA 5500/0%/RxC Select HMO 10/0% Select HMO 35/20% PPO 25/500/30% PPO 25/500/30% RxV PPO 35/1000/40% PPO 40/1800/40% PPO 40/1800/40% RxV PPO 45/1500/50% PPO 45/5000/10% Saver Were Employees of the employer covered by any other group health plan during the last 60 days? □ No □ Yes - Name of Provider (Carrier, HMO, MEWA, etc.): Policy #: Date of Termination:
MEDICAL PLAN SELECTION a. Medical coverage provided by the City will continue to be the lowest cost HMO medical plan as recommended by the Health Insurance Committee and approved by the City Council, and
