Out of Pocket Calculator Help

PPO Low Benefit

PPO Low 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 Low Benefit model assumes the following default benefit features:

General Individual Deductible: $1,000
General Family Deductible: $2,000
Inpatient Deductible Per Admission- Participating Hospitals: $250
Inpatient Deductible Per Admission- Non-Participating Hospitals: $750
Coinsurance- Participating Hospitals: 30%
Coinsurance- Non-Participating Hospitals: 50%
Maximum Allowable Per Day- Non Participating Hospitals: $1,200
Maximum Individual Annual Out of Pocket – Participating Providers: $3,000
Maximum Individual Annual Out of Pocket – Non Participating: $6,000
Maximum Family Annual Out of Pocket – Participating Providers: $4,000
Maximum Family Annual Out of Pocket – Non Participating: $8,000