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Health Options

You have two health options. Both are Preferred Provider Organization (PPO) plans:

In many ways, the Partnership PPO and Standard PPO are identical. They cover the same types of services, treatments and products. However, there’s an important difference between the two options: If you choose the Partnership PPO, the State will reward you with lower costs. Individuals who select the Partnership PPO will have to commit to a Partnership Promise.

How the Options Work

The following features apply to both options. Refer to the PPO comparison chart for the plans’ deductibles, co-pays, co-insurance and out-of-pocket maximum amounts.

 

Annual Deductible

Both options include an annual deductible. This is the amount you pay out of your pocket before the plan pays for hospital charges and other services that require co-insurance. It does not apply to services with a co-pay.

Co-insurance

Some services require that you pay co-insurance after you meet a deductible. Co-insurance is a percentage of the total cost.

Co-pays

Some services require that you pay a co-pay (instead of a deductible and co-insurance). A co-pay is a flat dollar amount, like $20 a visit.

Out-of-Pocket Maximum

The out-of-pocket maximum is the most you will pay for your deductible and co-insurance each year. It does not include your co-pays. Once you reach your out-of-pocket maximum, the plan pays 100% of covered medical expenses.

In-Network vs. Out-of-Network Providers

You can see any doctor or go to any health care facility you want. However, if you use an “in-network” provider, you will always pay less. That’s because an in-network provider agrees to provide services to our members at discounted rates. Broad networks of doctors and hospitals will continue to be available.