Medical Insurance 90/70 PPO
A PPO is a Preferred Provider Organization which pays a higher benefit percentage for services from an in-network provider, and a somewhat lesser benefit percentage for services from an out-of-network provider.
The 90/70 PPO plans both Medical Mutual (SuperMed Plus Network) and Anthem Blue Cross/Blue Shield (Blue Access Network) have a $250 single deductible and a $500 family deductible every calendar year.
- In these plans, you do not need a referral for specialist services.
- In-network inpatient, outpatient, and diagnostic services are covered at 90 percent AFTER the deductible is met.
- Out-of-network coverage for these services is covered at 70 percent AFTER the deductible has been met.
Some services have a copay amount which does not count toward the deductible. For example, an office visit to an in-network Primary Care Physician simply requires a $15 copay. Several routine services such as annual well-woman exams and well-child immunizations also require only the $15 copay, if an in-network provider is used. In-network coverage for routine mammograms and routine prostate specific antigen (PSA) testing is at 100 percent.
When will my insurance begin to pay for my medical expenses?
With the 90/70 and 80/60 "traditional" medical plans, you must meet the deductible before your insurance begins to pay toward your medical expenses.
Example 90/70 plan:
- After you have paid the $250 single deductible/$500 family deductible,
- Your insurance will begin to pay 90% toward your qualified medical expenses and you will continue to pay 10% (Co-Insurance) for your share of medical expenses.
- After you have paid the annual out-of-pocket maximum ($750 single maximum/$1,500 family maximum),
- Your insurance will begin to pay 100% of your qualified medical expenses.
NOTE: You will continue to pay your Office Co-pays throughout the year. Co-pays do not count toward meeting deductibles and/or annual out-of-pocket maximums.
This process is the same for the 80/60 medical plans. The exception are the deductible, co-insurance and maximum out of pocket amounts.