Navigator PPO

Care Advocates

PPO Value

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

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 Advantage HDHP

Affordable annual deductibles with zero coinsurance benefits after deductibles are met.

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