2017 Standard PPO
- The Standard Preferred Provider Organization (PPO) is a traditional health plan offering lower premiums and higher out-of-pocket costs.
This plan does not require the LivingWell Promise.
- This plan reimburses most covered expenses at 70%.
- Under this plan, you pay 30% of the total in-network prescription cost within a minimum and maximum range. Regardless of the pharmacy tier, the amount you pay is capped at a maximum amount.
- Emergency room co-pays are $150, plus the deductible and co-insurance.
- Medical and prescription out-of-pocket maximums accumulate separately.
2017 Standard PPO SBC
2017 Standard PPO SPD
2017 RX SPD Standard PPO
90-day retail pharmacies
ACA Preventive Drug List
Preferred Drug List-As of April 2017
Specialty Drug List-As of April 2017
See how your costs compare in the Standard PPO and the Standard CDHP options. The chart below is for illustrative purposes only.