Out of Pocket Calculator Help

PPO High Benefit

PPO High Benefit is one of the models to select from in the Select a Plan Model portion of the Plan Information section in the General Plan Information Sheet. “PPO” refers to a “Preferred Provider Organization” type of health plan. A PPO is a non-HMO health plan that has two levels of benefits: a relatively higher level of benefits apply when PPO participating providers are used, and a relatively lower level of benefits apply when non participating providers are used. The PPO High Benefit model assumes the following default benefit features:

General Individual Deductible: $500
General Family Deductible: $1,000
Inpatient Deductible Per Admission- Participating Hospitals: $0
Inpatient Deductible Per Admission- Non-Participating Hospitals: $250
Coinsurance- Participating Hospitals: 20%
Coinsurance- Non-Participating Hospitals: 30%
Maximum Allowable Per Day- Non Participating Hospitals: $2,400
Maximum Individual Annual Out of Pocket – Participating Providers: $1,750
Maximum Individual Annual Out of Pocket – Non Participating: $3,500
Maximum Family Annual Out of Pocket – Participating Providers: $2,500
Maximum Family Annual Out of Pocket – Non Participating: $5,000