Common use of PPO Plan Clause in Contracts

PPO Plan. In addition to the coverage specified in the current plan, the employer will provide a PPO Plan each year of the Agreement with an in-network annual medical deductible of five hundred ($500) dollars for each covered individual in the plan and children under age twenty-six (26) years as defined in the ACA. Regular office visits with a primary care doctor will require a twenty dollars ($20) copay, while office visits for specialists will require a forty dollars ($40) copay. See the simplified chart below for a brief summary of these and other key medical benefit provisions. PPO Plan Medical Benefits: In Network Out of Network Deductibles $500 per person $1000/family $1,000 per person $3,000/family Coinsurance 0% 20% Coinsurance Out of Pocket Max n/a $2,000/$6,000 Emergency Room Copay $100 – waived if admitted OV Copay/Specialist Copay $20/$30 30% Urgent Care Copay $40 30% OOP MAX SINGLE: $3,675 OOP MAX FAMILY: $7,350