The Health Net PPO Plan
A participant's annual PPO deductible and the PPO copayments and coinsurance amounts (up to the first $1,000) will be reimbursed by the SUP Welfare Plan upon submission of the Health Net payment explanation of benefits and proper receipts. If you use a Non-PPO provider, you will only be reimbursed up to the out of pocket amounts that would have been reimbursable had you used a PPO provider. Following are several examples:
- The Health Net Plan pays 80% of charges if a participant uses a PPO provider and 60% of charges if a participant uses a non-PPO provider. In this instance, a participant using a non-PPO provider will only be reimbursed the difference between the 60% allowed by Health Net and 80% which is the amount payable for a PPO provider (leaving 20% of the charges as the member's responsibility plus any amounts exceeding Health Net's customary and reasonable charge allowance). So for a $2,000 charge from a non-PPO provider, Health Net would pay $1,200 (assuming the deductible has been met); the Trust would reimburse you $400 and you will be required to pay $400.
- The Health Net Plan requires a $20 member copayment for an office visit to a PPO provider. A participant using a non-PPO provider will be reimbursed a maximum of $20 for an office visit. So for a $150 office visit charge from a non-PPO provider, Health Net would pay $90 (assuming the deductible has been met); the Trust would reimburse you $20 and you will be required to pay $40.
- The Health Net Plan requires an additional $500 copayment for inpatient hospitalization at a non-PPO facility. The $500 amount will not be reimbursable to you as this copayment applies only to non-PPO providers.
Spouses and dependents are not eligible for any deductible or coinsurance reimbursements. Please contact the Plan Office if you have any questions.