Common use of PPO Plan Clause in Contracts

PPO Plan. This plan is the Blue Cross Blue Shield of Michigan's PPO Option. $20 co-pay for office/urgent care visits in a network physician's office. $250 single/$500 family calendar year deductible in network and $500 single/$1,000 family deductible out-of-network. $1,250 single/$2,500 family annual out of pocket max in-network and $3,500 single/$7,000 family out of pocket max out of network. When services are provided by a community provider, the provider pays eighty percent (80%) of the reasonable amount as determined by the carrier after deductibles and the participant is responsible for the remaining charges. If services are received from a provider who is not a member of the Plan network, the plan pays sixty percent (60%) of the reasonable amount as determined by the carrier and the participant is responsible for the remaining charges. Specific policy terms are those in the executed insurance contract with the carrier. Medical benefits shall be provided as agreed to by the University and the Association. Coverage information will be on file in University Human Resources and additional information will be provided by the medical carriers. The PPO plan described above is subject to specific carrier policy provisions and the Group Operating Agreements between Oakland University and the carrier.