Personal choice ppo plan options
Personal Choice
Plan options
Personal Choice
PPO Gold $500
Personal Choice
PPO Gold $1,000
Personal Choice
PPO Silver $2,000
In-network Out-of-network In-network Out-of-network In-network Out-of-network
Level 1 Level 2 Level 1 Level 2 Level 1 Level 2
Annual deductible
(Individual)
$500 $1,500 $3,000 $1,000 $2,500 $5,000 $2,000 $4,000 $8,000
Annual deductible
(Family)
$1,000 $3,000 $6,000 $2,000 $5,000 $10,000 $4,000 $8,000 $16,000
Coinsurance Percentage 20% 40% 50% 20% 50% 30% 40% 50%
Embedded Coinsurance Maximum
(Individual)
$3,000 N/A N/A $2,000 N/A N/A N/A
Embedded Coinsurance Maximum
(Family)
$6,000 N/A N/A $4,000 N/A N/A N/A
Out-of-pocket maximum
(Individual)
$6,600 $13,200 $6,600 $13,200 $6,600 $13,200
Out-of-pocket maximum
(Family)
$13,200 $26,400 $13,200 $26,400 $13,200 $26,400
Office visit copays $20 $40 N/A $20 $40 N/A $40 $50 N/A
Pharmacy copays $15 $50 N/A $15 $50 N/A $20 $60 N/A

Find more details about this plan in the Personal Choice PPO Benefits Certificate (PDF).

Certificates are legal documents that describe the benefits of a health insurance plan. Your plan might have different benefits and limitations than those listed in this document.