Navigator PPO

Care Advocates

PPO Advantage HDHP

Navigator PPO Plans offer a three-tier benefit structure that gives employees the flexibility to choose care that best fits their health and financial needs.

All PPO Plans include access to Care Advocates who can negotiate lower costs for certain care at hospitals and facilities, often with a $0 copay, when you contact a Care Advocate prior to receiving hospital and facility care. Coverage and costs vary by plan.

Tier 1Care Advocate 4000 Plan 4500 Plan 6000 Plan 6500 Plan
Deductible (Single / Family) None None None None
Out-of-Pocket Limit (Single / Family) None None None None
Tier 2In-Network 4000 Plan 4500 Plan 6000 Plan 6500 Plan
Deductible (Single / Family) $4,000 / $8,000 $4,500 / $9,000 $6,000 / $12,000 $6,500 / $13,000
Out-of-Pocket Limit (Single / Family) $7,050 / $14,100 $7,050 / $14,100 $7,050 / $14,100 $7,050 / $14,100
Tier 3Out-of-Network 4000 Plan 4500 Plan 6000 Plan 6500 Plan
Deductible (Single / Family) $8,000 / $16,000 $9,000 / $18,000 $12,000 / $24,000 $13,000 / $26,000
Out-of-Pocket Limit (Single / Family) Unlimited Unlimited Unlimited Unlimited
Schedule of Benefits Schedule of Benefits Schedule of Benefits Schedule of Benefits

Care Advocates

The cost of care at hospitals and facilities can be expensive for both members and employers. Care Advocates can negotiate lower costs on your behalf, often with a $0 copay.

The benefit coinsurances and copayments listed here are for Navigator PPO Advantage HDHP 4000. Please see the full Plan Summaries for Navigator PPO Advantage HDHP 4500, 6000, and 6500.

Physician & Ancillary Services Care Advocate In-Network Out-of-Network
Primary Care Office Visit Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Specialist Office Visit Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Other Services (Performed in Office) Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Physician Services (Performed in a Facility) Not Applicable 20% Coinsurance ** § 50% Coinsurance *** §
Urgent Care Visit Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Maternity Physician Services Not Applicable 20% Coinsurance ** §§ 50% Coinsurance *** §§
Lab Services (Non-Hospital) Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Rehab & Therapy (Non-Hospital) Not Applicable 20% Coinsurance ** § 50% Coinsurance *** §
Alternative Care (Chiropractic, Acupuncture, Massage Therapy) Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Facility-Based Services Care Advocate In-Network Out-of-Network
Emergency Services Hospital ER (Facility Charge Only) Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Ambulance – Emergent (Ground Only) Not Applicable 20% Coinsurance ** 50% Coinsurance ***
Radiology (Hospital Outpatient) Not Applicable 20% Coinsurance ** § 50% Coinsurance *** §
Dialysis & Supplies Not Applicable $3,050 Copayment ** § 50% Coinsurance *** §
Outpatient Services (Cardiac, Pulmonary, PT, OT, ST) 0% Copay / 0% Coinsurance * 20% Coinsurance ** § 50% Coinsurance *** §
Outpatient Surgeries 0% Copay / 0% Coinsurance * 20% Coinsurance ** § 50% Coinsurance *** §
Inpatient Hospitalizations 0% Copay / 0% Coinsurance * 20% Coinsurance ** § 50% Coinsurance *** §
Transplant Procedures 0% Copay / 0% Coinsurance * $3,050 Copayment ** § 50% Coinsurance *** §
Prescription Drug Benefits Care Advocate In-Network Out-of-Network
Preventive Prescription Services (Prescription Drugs, Pharmacy Retail – up to a 30-Day Supply) Not Applicable Generic - $0 Copayment Not Covered
Non-Preventive Prescription Services (Prescription Drugs, Pharmacy Retail – up to a 30-Day Supply) Not Applicable Generic / Preferred Brand - 20% Coinsurance ** Not Covered
Specialty Drugs Not Applicable 20% Coinsurance ** Not Covered

Navigator PPO

View other Navigator PPO Plans

PPO

PPO Prime

Large provider network with low copays and zero coinsurance for most physicians and ancillary care.

PPO

PPO Choice

Lowest annual deductible options with low coinsurance for most physicians and ancillary care.

PPO

PPO Value

Low annual deductibles with coinsurance benefits after deductibles are met.

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