Active Member Info: PPO
Summary
- Preferred Provider Organization (PPO) offers both an in-network and an out-of-network benefit.
- In order to receive the highest level of benefits, you must choose one of the in-network physicians or facilities.
- You may self refer for medically necessary care. There is no need to have your care coordinated by a Primary Care Physician (PCP).
- $15 copayment for PCP office visits during regular hours.
- $25 copayment for specialist office visits.
- $50 copayment for emergency room visit (waived if admitted to a hospital).
- Out-of-Network: Annual deductible - $400 per person; Plan payment - 70% of next $5,000, 100% in excess of $5,000; Out-of-pocket maximum $1,500 ($3,000 per family)
Check with the PEBTF if you have any questions reqarding the PPO Option.
For more information, refer to your Summary Plan Description or contact PEBTF.
