Information About Preferred Provider Organization (PPO) Options

Information About Preferred Provider Organization (PPO) Options

With the addition of three new PPO plans, there will now be four different options available for health insurance. This information is to help compare these four options so employees can decide what plan to choose.

Click which coverage option you would like to compare:
Employee Only
Employee Spouse
Employee Child
Employee Family

Click for examples of PPO plans In-Network and Out-of-Network Cost:
Smart Choice Basic
Smart Choice
Smart Choice Plus

Employee Only Coverage Option
For employees the cost would be:

Scheduled Hours	CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
30 to 40	$0	$0	$0	$39.54
20 to 29	$321.14	$311.52	$311.52	$351.06

Note: The Smart Choice Basic offers no premium savings. Only if employees know they will have a status change during that year would it offer savings.

Annual Deductible:
CMM	Smart Choice Basic		Smart Choice		Smart Choice Plus
	In-Network	Out-of-network	In-Network	Out-of-network	In-Network	Out-of-network
$350	$600	$1,200	$300	$600	$150	$300
Employee Coinsurance:
20%	30%	50%	20%	40%	10%	30%
Plan Coinsurance:
80%	70%	50%	80%	60%	90%	70%
Physician Office Visits About Primary Care:
$15 + D&C*	$25	Covered after D&C*	$20	Covered after D&C*	$15	Covered after D&C*
Physician Office Visits About Specialist:
$15 + D&C*	$50	Covered after D&C*	$40	Covered after D&C*	$30	Covered after D&C*
Physician Office Visits About Urgent Care:
	$75	$75	$50	$50	$50	$50
Outpatient Hospital & Ambulatory Surgical Center Copay:
$75, then D&C*	D&C*	D&C*	D&C*	D&C*	D&C*	D&C*
Coinsurance Maximum:
$2,000	$2,500	$5,000	$1,750	$3,500	$1,000	$2,000
For Wellness Benefits (annual):
$150	Per Benefit**	Not covered	Per Benefit**	Not covered	Per Benefit**	Not covered

* D&C = Deductible & Coinsurance

** Physicals, annual Ob/Gyn visits, and eye exams covered at 100% after copay. Mammograms and laboratory services covered at 100% when performed without additional services.

For Inpatient Copay:
CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
$150, then D&C*	$200, then D&C*	$150, then D&C*	$100, then D&C*
Empergency Room Copay:
$200, then D&C*	$250, then D&C*	$200, then D&C*	$150, then D&C*
Lifetime Maximum:
$5 million	Unlimited	Unlimited	Unlimited

* D&C = Deductible & Coinsurance

Here are two preventive care examples:

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$240***	$0
Total	$415	$265	$20

*** Member has not met calendar year deductible. Full cost applied to $350 deductible.

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$48***	$0
Total	$415	$73	$20

*** Member has met calendar year deductible. Only 20% coinsurance applies.

Employee Spouse Coverage Options

For employees the cost would be:

Scheduled Hours	CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
30 to 40	NA	$349.08	$415.14	$507.38
20 to 29	NA	$660.60	$726.66	$818.90

Annual Deductible:
CMM	Smart Choice Basic		Smart Choice		Smart Choice Plus
	In-Network	Out-of-network	In-Network	Out-of-network	In-Network	Out-of-network
NA	$1,800	$3,600	$900	$1,800	$450	$900
Employee Coinsurance:
NA	30%	50%	20%	40%	10%	30%
Plan Coinsurance:
NA	70%	50%	80%	60%	90%	70%
Physician Office Visits About Primary Care:
NA	$25	Covered after D&C*	$20	Covered after D&C*	$15	Covered after D&C*
Physician Office Visits About Specialist:
NA	$50	Covered after D&C*	$40	Covered after D&C*	$30	Covered after D&C*
Physician Office Visits About Urgent Care:
NA	$75	$75	$50	$50	$50	$50
Outpatient Hospital & Ambulatory Surgical Center Copay:
NA	D&C*	D&C*	D&C*	D&C*	D&C*	D&C*
Coinsurance Maximum:
NA	$7,500	$15,000	$5,250	$10,500	$3,000	$6,000
Wellness Benefits (annual):
NA	Per Benefit**	Not covered	Per Benefit**	Not covered	Per Benefit**	Not covered

* D&C = Deductible & Coinsurance

** Physicals, annual Ob/Gyn visits, and eye exams covered at 100% after copay. Mammograms and laboratory services covered at 100% when performed without additional services.

Inpatient Copay:
CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
NA	$200, then D&C*	$150, then D&C*	$100, then D&C*
Empergency Room Copay:
NA	$250, then D&C*	$200, then D&C*	$150, then D&C*
Lifetime Maximum:
NA	Unlimited	Unlimited	Unlimited

Employee Child Coverage Options

For employees the cost would be:

Scheduled Hours	CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
30 to 40	$200.18	$135.48	$180.18	$242.60
20 to 29	$521.32	$447.00	$491.70	$554.12

Annual Deductible:
CMM	Smart Choice Basic		Smart Choice		Smart Choice Plus
	In-Network	Out-of-network	In-Network	Out-of-network	In-Network	Out-of-network
$1,050	$1,800	$3,600	$900	$1,800	$450	$900
Employee Coinsurance:
20%	30%	50%	20%	40%	10%	30%
Plan Coinsurance:
80%	70%	50%	80%	60%	90%	70%
Physician Office Visits About Primary Care:
$15 + D&C*	$25	Covered after D&C*	$20	Covered after D&C*	$15	Covered after D&C*
Physician Office Visits About Specialist:
$15 + D&C*	$50	Covered after D&C*	$40	Covered after D&C*	$30	Covered after D&C*
Physician Office Visits About Urgent Care:
	$75	$75	$50	$50	$50	$50
Outpatient Hospital & Ambulatory Surgical Center Copay:
$75, then D&C*	D&C*	D&C*	D&C*	D&C*	D&C*	D&C*
Coinsurance Maximum:
$6,000	$7,500	$15,000	$5,250	$10,500	$3,000	$6,000
For Wellness Benefits (annual):
$150	Per Benefit**	Not covered	Per Benefit**	Not covered	Per Benefit**	Not covered

* D&C = Deductible & Coinsurance

** Physicals, annual Ob/Gyn visits, and eye exams covered at 100% after copay. Mammograms and laboratory services covered at 100% when performed without additional services.

Inpatient Copay:
CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
$150, then D&C*	$200, then D&C*	$150, then D&C*	$100, then D&C*
Empergency Room Copay:
$200, then D&C*	$250, then D&C*	$200, then D&C*	$150, then D&C*
Lifetime Maximum:
$5 million	Unlimited	Unlimited	Unlimited

* D&C = Deductible & Coinsurance

Here are two preventive care examples:

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$240***	$0
Total	$415	$265	$20

*** Member has not met calendar year deductible. Full cost applied to $350 deductible.

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$48***	$0
Total	$415	$73	$20

*** Member has met calendar year deductible. Only 20% coinsurance applies.

Employee Family Coverage Options
For employees the cost would be:

Scheduled Hours	CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
30 to 40	$480.14	$371.82	$440.14	$535.54
20 to 29	$801.28	$683.34	$751.66	$847.06

Annual Deductible:
CMM	Smart Choice Basic		Smart Choice		Smart Choice Plus
	In-Network	Out-of-network	In-Network	Out-of-network	In-Network	Out-of-network
$1,050	$1,800	$3,600	$900	$1,800	$450	$900
Employee Coinsurance:
20%	30%	50%	20%	40%	10%	30%
Plan Coinsurance:
80%	70%	50%	80%	60%	90%	70%
Physician Office Visits About Primary Care:
$15 + D&C*	$25	Covered after D&C*	$20	Covered after D&C*	$15	Covered after D&C*
Physician Office Visits About Specialist:
$15 + D&C*	$50	Covered after D&C*	$40	Covered after D&C*	$30	Covered after D&C*
Physician Office Visits About Urgent Care:
	$75	$75	$50	$50	$50	$50
Outpatient Hospital & Ambulatory Surgical Center Copay:
$75, then D&C*	D&C*	D&C*	D&C*	D&C*	D&C*	D&C*
Coinsurance Maximum:
$6,000	$7,500	$15,000	$5,250	$10,500	$3,000	$6,000
For Wellness Benefits (annual):
$150	Per Benefit**	Not covered	Per Benefit**	Not covered	Per Benefit**	Not covered

* D&C = Deductable & Coinsurance

** Physicals, annual Ob/Gyn visits, and eye exams covered at 100% after copay. Mammograms and laboratory services covered at 100% when performed without additional services.

For Inpatient Copay:
CMM	Smart Choice Basic	Smart Choice	Smart Choice Plus
$150, then D&C*	$200, then D&C*	$150, then D&C*	$100, then D&C*
Empergency Room Copay:
$200, then D&C*	$250, then D&C*	$200, then D&C*	$150, then D&C*
Lifetime Maximum:
$5 million	Unlimited	Unlimited	Unlimited

* D&C = Deductable & Coinsurance

Here are two preventive care examples:

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$240***	$0
Total	$415	$265	$20

*** Member has not met calendar year deductible. Full cost applied to $350 deductible.

Service	Cost	CMM MemberCost	Smart Choice Member Cost
Annual Physical	$175	$25	$20
Mammogram	$240	$48***	$0
Total	$415	$73	$20

*** Member has met calendar year deductible. Only 20% coinsurance applies.

Smart Choice Basic plan example of In and Out of Network Cost:

	In-Network	Out-of-Network
A. Total Bill	$5,000	$5,000
B. Allowed Amount	$4,300	$4,300
C. Deductible Amount	$600	$1,200
D. Allowed Amount Minus Deductible (B-C)	$3,700	$3,100
E. Your Coinsurance Amount	(30%) $1110	(50%) $1,550
F. Amount You Owe Over Allowed Amount	$0 (in-network charges limited to Allowed Amount)	$700 (difference between Total Bill and Allowed Amount)
G. Total Amount You Owe (C+E+F)	$1,710	$3,450

Smart Choice plan example of In and Out of Network Cost:

	In-Network	Out-of-Network
A. Total Bill	$5,000	$5,000
B. Allowed Amount	$4,300	$4,300
C. Deductible Amount	$300	$600
D. Allowed Amount Minus Deductible (B-C)	$4,000	$3,700
E. Your Coinsurance Amount	(20%) $800	(40%) $1,480
F. Amount You Owe Over Allowed Amount	$0 (in-network charges limited to Allowed Amount)	$700 (difference between Total Bill and Allowed Amount)
G. Total Amount You Owe (C+E+F)	$1,100	$2,780

Smart Choice Plus plan example of In and Out of Network Cost:

	In-Network	Out-of-Network
A. Total Bill	$5,000	$5,000
B. Allowed Amount	$4,300	$4,300
C. Deductible Amount	$150	$300
D. Allowed Amount Minus Deductible (B-C)	$4,150	$4,000
E. Your Coinsurance Amount	(10%) $415	(30%) $1,200
F. Amount You Owe Over Allowed Amount	$0 (in-network charges limited to Allowed Amount)	$700 (difference between Total Bill and Allowed Amount)
G. Total Amount You Owe (C+E+F)	$565	$2,200

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Information About Preferred Provider Organization (PPO) Options

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