Physician Choice PPO Plan Options
Physician Choice
Plan options
Physician Choice
PPO Gold $1,000
Physician Choice
PPO Silver $4,000
In-network Out-of-network In-network Out-of-network
Level 1 Level 2 Level 1 Level 2
Annual deductible
(Individual)
$1,000 $2,500 $5,000 $4,000 $5,500 $9,000
Annual deductible
(Family)
$2,000 $5,000 $10,000 $8,000 $11,000 $18,000
Coinsurance Percentage 20% 50% 30% 40% 50%
Embedded Coinsurance Maximum
(Individual)
$2,000 N/A N/A N/A
Embedded Coinsurance Maximum
(Family)
$4,000 N/A N/A N/A
Out-of-pocket maximum
(Individual)
$6,600 $13,200 $8,150 $15,800
Out-of-pocket maximum
(Family)
$13,200 $26,400 $15,800 $31,600
PCP office visit copays $20 $40 N/A $40 $50 N/A
Preferred generic pharmacy copays $15 $50 N/A $30 $30 N/A

Find more details about this plan in the Physician 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.