Summary Plan Description

Introduction

This Section Is For Individuals Without Medicare
A preferred provider organization or PPO is an independent company that contracts with hospitals, physicians, clinics, chiropractors, chemical dependency facilities, laboratories, medical equipment suppliers, mental health agencies, and a number of other provider types. This network of providers provides you and your dependents with efficient, cost-effective care in exchange for the plan's participation in the network.

Although you may receive care from any licensed provider covered by this plan, your benefits are enhanced if you receive care from a preferred provider. Preferred providers offer the following important advantages:

  • When you use a provider from the preferred network, you do not pay the additional $10 office visit copayment required when a nonpreferred provider bills an office call.
  • When you use a hospital or other facility from the preferred network, you do not pay the $200 inpatient copayment required when a nonpreferred facility bills an inpatient admission.
  • Most preferred providers discount their services which means less out-of-pocket expenses. Failure to use a preferred provider may also result in a reduction of benefits. A direct billing and payment system between this plan and the provider or facility eliminates most paperwork.

Helpful Hint

The $10 office copayment and $200 inpatient hospital copayment do not apply to care received outside the preferred provider network.