Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If a preferred provider is not used, coinsurance will be reduced to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare and subject to the single and family deductibles and out-of-pocket maximums listed in Appendix D. Any network modifications made by the plan administrator will apply. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If the participating providers are not used, coinsurance reduces to sixty/forty percent (60/40%). The additional twenty percent (20%) coinsurance is the employee's responsibility and not subject to the out-of-pocket maximum. Any PPO network modifications by the Plan Administrator will apply. Effective January 1, 2018, if a preferred provider is not used, coinsurance will be reduced to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare and subject to the single and family deductibles and out-of-pocket maximums listed in Appendix D. Any network modifications made by the plan administrator will apply.
Medical PPO. If a member and/or dependent receive services from a preferred provider organization (PPO), reimbursements will be eighty/twenty percent (80/20%) coinsurance. If the participating providers are not used, coinsurance reduces to sixty/forty percent (60/40%). The additional twenty percent (20%) coinsurance is the employee's responsibility and not subject to the out-of-pocket maximum. Any PPO network modifications by the Plan Administrator will apply.
