PPO Plan Comparison for Preventive Physicals

Comparison – PPO Plan 1 Tier #1 vs. PPO Plan 1 Tier #2 Medical Plan Sarah’s annual preventive physical & takes no ongoing medications. (Single Coverage, Teacher) PPO Plan 1 Tier #1 PPO 1 Plan Tier #2 • Plan Deductible……………………………………….........…$2,000/$4,000 • Plan Deductible………………………………….…….$5,000/$10,000 • Coinsurance……………………………………....……….…………..…..….20% • Coinsurance…………………………...………………………………..20% • Copays……………………………………………………………………..……..$15 • Copays………………….………………….....…………..…………….……$40 This example event includes services like: This example event includes services like: • Primary Care physician office visits (including disease • Primary Care physician office visits (including disease education) education) • Diagnostic Tests (blood work) • Diagnostic Tests (blood work) • Prescription drugs • Prescription drugs • Preventive Wellness Physical • Preventive Wellness Physical • Durable medical equipment • Durable medical equipment Total Example Cost $0 Total Example Cost $0 In this example, Sarah would pay: In this example, Sarah would pay: Cost Sharing Cost Sharing Deductibles $0 Deductibles $0 Coinsurance $0 Coinsurance $0 Copayments $0 Copayments $0 Sarah’s Total Cost $0 Sarah’s Total Cost $0