PPO

One of three available Medical Plan options, the preferred provider organization (PPO) option provides the highest level of coverage and offers the most flexibility. The PPO is the only medical option available through the Board of Pensions that includes out-of-network benefits, offering employees the freedom to seek care from both network and out-of-network providers.

As part of our commitment to wholeness and mutual care, the Medical Plan is designed to promote shared responsibility for healthcare costs. PPO deductibles are based on salaries so those with the greatest resources may help those with the least.

Coverage details

Here are key details about PPO coverage:

• Out-of-pocket costs are typically lower when using network providers. PPO participants have access to the Blue Cross Blue Shield national network of physicians, hospitals, and other healthcare providers.
• Members pay a flat copay for each doctor's office or urgent care center visit, or when using the plan's telemedicine benefit.
• Members pay an annual deductible based on their effective salary for inpatient hospital stays, surgery, diagnostic tests, emergency room visits, and other care. When the deductible is reached, members pay 20 percent (their coinsurance) and the plan pays 80 percent for these services.
• The PPO includes an annual medical out-of-pocket maximum, which is the most members may pay in the form of coinsurance in a given year. When the annual medical out-of-pocket maximum amount is met, the plan pays 100 percent of allowable charges for the rest of the calendar year (members continue to pay copays for doctor’s office visits until the annual total maximum out-of-pocket amount is met). The medical out-of-pocket maximum is also salary-based. A separate out-of-pocket maximum applies for prescription drugs.

Read more details about costs to PPO participants.

Value-added features

The PPO includes unique features — available with all Medical Plan options — that provide exceptional value and promote well-being and wholeness.

• Generous preventive care benefits
• Pharmacy benefits
• Call to Health
• Teladoc
• Employee Assistance Plan
• Centers of Excellence
• Livongo for Diabetes Program

Personalized support through care navigation

All three medical options also include care navigation, provided in partnership with Quantum Health. Care navigation guides members and their covered family members to high-quality care and helps them make the most of their medical benefits. It enhances the value of medical benefits through the Board of Pensions — at no additional cost to the member or employer.

Eligibility to participate

You may choose to offer the PPO to employees who are regularly scheduled to work at least 20 hours a week. There is no work-hour requirement for ministers in self-employed validated service to participate in this coverage option. PPO medical coverage for family is included in the Pastor's Participation benefits package.