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2018 Standard PPO


The Standard Preferred Provider Organization (PPO) is a traditional health plan offering lower premiums and higher out-of-pocket costs.

            • You pay 30% and the health plan pays 70% once your deductible is met.
            • Your emergency room co-pays are $150, plus your deductible and co-insurance.
            • You pay 30% of the total in-network prescription costs, subject to a minimum and maximum (capped) amount.
            • Your medical and prescription out-of-pocket costs accumulate separately.
            • You are not required to complete the LivingWell Promise with this plan option, but you can use the Go365 wellness benefit and earn incentives.

If you did not elect or waive your health insurance coverage by October 20, 2017, you were automatically enrolled in this plan with the same coverage level you had in plan year 2017.


The chart below is for illustrative purposes only.


2018 Standard PPO SBC
2018 Standard PPO SPD
2018 RX SPD Standard PPO
Benefits Grid
90-day retail pharmacies
ACA Preventive Drug List
Preferred Drug List