PPO

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

woman at doctor visit

Here's why the PPO option may be right for you:

  • Out-of-pocket costs are typically lower when using network 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 copayment) and the plan pays 80 percent for these services.
  • When the annual copayment maximum amount is met, the plan pays 100 percent of allowable charges for the rest of the calendar year.

Medical Plan coverage

Employees enrolled in the PPO have access to the Blue Cross Blue Shield (BCBS) network of physicians, hospitals, and other healthcare providers. The PPO encourages use of network physicians and hospitals to access

  • preventive care benefits;
  • hospital and medical/surgical coverage;
  • behavioral health benefits; and
  • prescription drug coverage.

The PPO also provides resources to improve well-being.

Employees and covered family members may use out-of-network providers but will pay a greater share of the cost if they do.

Eligibility

Employers may choose to offer PPO coverage through menu options to ministers of the Word and Sacrament and 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 the PPO.

Installed pastors must be enrolled in PPO coverage through Pastor's Participation, a comprehensive benefits package designed to meet the needs of installed pastors and their families. Employers are encouraged to enroll all ministers working at least 20 hours per week in Pastor's Participation. The eligible family members of these ministers are automatically covered.

Cost of coverage

For medical coverage under menu options, employers may offer either the PPO, the EPO, or the HDHP; any two options; or all three. The employer must contribute at least 50 percent of the cost of Member-only coverage in the lowest cost option offered — regardless of which option or coverage level the employee elects.

Employees enrolled in menu options may be required to pay

  • the balance of the cost for Member-only coverage; and/or
  • up to 100 percent of the incremental cost of coverage for their eligible family members.

For ministers enrolled in Pastor's Participation, employers must provide full family coverage at no cost to the ministers.

Preventive care

For those enrolled in the Medical Plan, the preventive care benefit covers 100 percent of the plan allowance for eligible preventive screenings and immunizations with a network provider and is not subject to a deductible.

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Prescription drug benefits

Prescription drug benefits are automatically included with all medical options. Benefits are administered by OptumRx, which offers a national network of participating pharmacies, including a mail-order pharmacy, and maintains a formulary of preferred prescription medications.

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