With the PPO copay option, you have higher premiums, but you benefit from lower, more predictable expenses when you seek care.
Here's how it works:
- You pay a copay each time you seek medical care within the Ascension Network — like visiting a doctor or going to urgent care.
- You don't have a deductible or coinsurance like there is with other medical plans, as long as you stay in the Ascension Network.
- Finally, if you reach the maximum amount for paying out of pocket, $3,000 individual / $6,000 family (includes medical and prescription), then your eligible medical expenses are completely covered by SmartHealth for the remainder of the year, when you receive care within the Ascension Network.
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- Compare costs based on the provider network in a side-by-side chart.
- Compare key features of each plan and the payroll deductions.
- You can also view the Summary Plan Description for more information.
To review how costs are shared, visit the Summary of Benefits and Coverage page for each plan option.
Note: Different deductibles, coinsurance and out-of-pocket maximum amounts apply when you use National Network or out-of-network providers and facilities.
Rx Costs and PPO Copay
If you choose the PPO copay option, your prescription cost is based upon the type of medication you use. If you select a generic medication or a specialty drug, you will pay a copay. If you fill your prescription with a brand drug (preferred or non-preferred), you pay coinsurance.
The copay and coinsurance amounts count toward your out-of-pocket maximum. Once you reach your out-of-pocket maximum, your prescriptions are covered 100% for the remainder of the year.
The SmartHealth Flexible Copay program identifies coupons and patient assistance provided by the medication's manufacturer. Your copays may be reduced at preferred pharmacies for flexible copay medications. However, these coupons and manufacturer's patient assistance will not apply to your out-of-pocket costs for the year with the PPO copay option.
Health Accounts and PPO Copay
If you enroll in the PPO copay option, you can also enroll in a healthcare flexible spending account (FSA) to pay for your copays. If you enroll in the PPO copay option, you can also enroll in a healthcare flexible spending account (FSA) to pay for your copays. Learn more.