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 | 2500 Plan | 3500 Plan | 6850 Plan |
---|---|---|---|
Deductible (Single / Family) | None | None | None |
Out-of-Pocket Limit (Single / Family) | None | None | None |
Tier 2In-Network | 2500 Plan | 3500 Plan | 6850 Plan |
Deductible (Single / Family) | $2,500 / $5,000 | $3,500 / $7,000 | $6,850 / $13,700 |
Out-of-Pocket Limit (Single / Family) | $8,700 / $17,400 | $8,700 / $17,400 | $8,700 / $17,400 |
Tier 3Out-of-Network | 2500 Plan | 3500 Plan | 6850 Plan |
Deductible (Single / Family) | $7,000 / $14,000 | $9,000 / $18,000 | $15,700 / $31,400 |
Out-of-Pocket Limit (Single / Family) | Unlimited | Unlimited | Unlimited |
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 Value 2500. Please see the full Plan Summaries for Navigator PPO Value 3500 and 6850.
Physician & Ancillary Services | Care Advocate | In-Network | Out-of-Network |
---|---|---|---|
Primary Care Office Visit | Not Applicable | $5 Copay (Per Visit) | 70% Coinsurance *** |
Specialist Office Visit | Not Applicable | $50 Copay (Per Visit) | 70% Coinsurance *** |
Other Services (Performed in Office) | Not Applicable | 50% Coinsurance ** | 70% Coinsurance *** |
Physician Services (Performed in a Facility) | Not Applicable | 50% Coinsurance ** § | 70% Coinsurance *** § |
Urgent Care Visit | Not Applicable | $50 Copay (Per Visit) | 70% Coinsurance *** |
Maternity Physician Services | Not Applicable | 50% Coinsurance ** §§ | 70% Coinsurance *** §§ |
Lab Services (Non-Hospital) | Not Applicable | 50% Coinsurance ** | 70% Coinsurance *** |
Rehab & Therapy (Non-Hospital) | Not Applicable | 50% Coinsurance ** § | 70% Coinsurance *** § |
Alternative Care (Chiropractic, Acupuncture, Massage Therapy) | Not Applicable | $50 Copay (Per Visit) | 70% Coinsurance *** |
Facility-Based Services | Care Advocate | In-Network | Out-of-Network |
Emergency Services Hospital ER (Facility Charge Only) | Not Applicable | $1,000 Copay ‡ | $1,000 Copay ‡‡ |
Ambulance – Emergent (Ground Only) | Not Applicable | $500 Copay ††† | $500 Copay †† |
Radiology (Hospital Outpatient) | Not Applicable | 50% Coinsurance ** § | 70% Coinsurance *** § |
Dialysis & Supplies | Not Applicable | $6,200 Copayment ** § | 70% Coinsurance *** § |
Outpatient Services (Cardiac, Pulmonary, PT, OT, ST) | 0% Copay / 0% Coinsurance * | $50 Copay ††† § | $50 Copay †† § |
Outpatient Surgeries | 0% Copay / 0% Coinsurance * | $1,000 Copay ††† § | $1,000 Copay †† § |
Inpatient Hospitalizations | 0% Copay / 0% Coinsurance * | $1,500 Copay ††† § | $1,500 Copay †† § |
Transplant Procedures | 0% Copay / 0% Coinsurance * | $6,200 Copayment ** § | 70% 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 - $10 Copay Preferred Brand - $20 Copay |
Not Covered |
Specialty Drugs | Not Applicable | 50% Coinsurance | Not Covered |