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Indiana State Personnel Department

Traditional PPO Traditional PPO (2012)

A Traditional Preferred Provider Organization health plan (Traditional PPO) offered through the state of Indiana provides the same coverage as a consumer-driven health plan. That coverage includes 100% coverage for preventive care.

If you decide in January to have a flu shot and you have health plan coverage through the state of Indiana, even if you have not met your deductible, the vaccination is considered preventive—that means you do not pay for it. On the flip side, preventive services do not count toward your deductible. However, prescription costs, doctor visits, etc., do count toward your deductible.

The Traditional PPO features a significantly higher premium. The PPO has agreements with multiple providers (hospitals, doctors, specialists, etc.), which makes up the provider network. Under this network, there are generally lower costs for services from the in-network providers than those outside the network. Employees who select the Traditional PPO can choose to use a provider not in the network, but that will probably be more expensive than using the services of a provider in the PPO network.

Traditional PPO rates

Plan Coverage Bi-Weekly Employee Rate Bi-Weekly Employer Rate Bi-Weekly Total Rate Annual Employee Rate Annual Employer Rate
Trad PPO Single
Family
$151.27
$376.40
$196.55
$569.44
$347.82
$945.84
$3,933.02
$9,786.40
$5,110.30
$14,805.44
Trad PPO w/ Non-tobacco incentive Single
Family
$126.27
$351.40
$196.55
$569.44
$322.82
$920.84
$3,283.02
$9,136.40
$5,110.30
$14,805.44

As a Traditional PPO subscriber, you will pay a biweekly premium and the PPO will charge a copayment for each service rendered (for example, an office visit). Once your deductible is met, you will pay 30% of the negotiated cost until your maximum out-of-pocket is met.

When deciding which health plan is best for you and your family, it is important that you take time to study all costs involved. That means looking at the premiums, deductibles, out-of-pocket maximums for each plan. Then examine those costs in light of what you spent in 2011 for health care needs. Armed with that information, log onto the Benefits Calculator (http://www.in.gov/spd/2527.htm) and let it help you determine what would work best in meeting your financial and health care needs for 2012.