Benefit structure of FFS and PPO plans by pay type
Hourly | Salaried | |||||
---|---|---|---|---|---|---|
FFS | PPO | FFS | PPO | |||
Deductible | None | None | *$300-*$600* | None | ||
Coinsurance | None | None† | 20% | 10% | ||
Office visit | 0% coverage | 50-70% coverage‡ | 80% coverage | 90% coverage§ | ||
FOBT∥ | 100% coverage | 100% coverage | 100% coverage | 100% coverage | ||
Sigmoidoscopy¶ | 0% coverage | 0% coverage | 0% coverage | 0% coverage | ||
Colonoscopy¶ | 0% coverage | 0% coverage | 0% coverage | 0% coverage | ||
DCBE¶ | 0% coverage | 0% coverage | 0% coverage | 0% coverage |
↵* *$300 for individual coverage and *$600 for family coverage.
↵† 80% coverage if enrollee goes out of approved network unless referred by network physician.
↵‡ Plan-specific.
↵§ 70% coverage if out-of-network physicians used; enrollee pays the balance.
↵∥ Deductible and coinsurance provisions waived.
↵¶ From 1995 through 1999, 100% covered if ordered for diagnostic purposes.