Comparison of PPO Plan 2 Tier #1 vs. PPO Plan 2 Tier #2 for Family Coverage

This document provides a cost comparison for family medical coverage options under Jackie's PPO Plan 2, including details on deductibles, coinsurance, and copays for various services.

Comparison – PPO Plan 2 Tier #1 vs. PPO Plan 2 Tier #2 Medical Plan Jackie is having a baby (Family Coverage, Teacher) PPO Plan 2 Tier #1 PPO Plan 2 Tier #2 • Plan Deductible…………………………………….......$3,000/$6,000 • Plan Deductible……………………………….........…$6,000/$12,000 • • Coinsurance……………………………………....…………….……..….20% Coinsurance……………………………………....…………….……..….20% • • Copays……………………………………………………..………………….$15 Copays……………………………………………………..………………..$40 • Maximum out-of-pocket………………………..$7,350/$14,700 • Maximum out-of-pocket………………….……..$7,3500/$14,700 This example event includes services like: This example event includes services like: • • Specialist Office Visits (Prenatal Care) Specialist Office Visits (Prenatal Care) • Specialist visit (anesthesia) • Specialist visit (anesthesia) • • Delivery/hospital Delivery/hospital • • Diagnostic Tests (blood work and ultrasounds) Diagnostic Tests (blood work and ultrasounds) • Preventive Wellness Physical • Preventive Wellness Physical Total Example Cost $10,453 Total Example Cost $10,453 In this example, Jackie would pay: In this example, Jackie would pay: Cost Sharing Cost Sharing Deductibles $10,453 Deductibles $6,000 Coinsurance $0 Coinsurance $890.60 Copayments $0 Copayments $0 Jackie’s Total Cost $10,453.00 Jackie’s Total Cost $6,890.60