黑料社区

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PPO Plan

Miami's PPO plan offers lower deductibles, coinsurance and set copayments.

PPO Plan Summary

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Plan Summary Effective January 1, 2024
Service Network Tier 1⇒
Member Pays		 Network Tier 2⇒ Member Pays Out-of-Network Benefits
Member Pays**
Calendar Year Deductible $350 individual
$700 family		 $5,000 single
$10,000 family
Medical Out-of-Pocket Maximum
(deductible, coinsurance, and medical copays)		 $2,350 individual
$4,700 family		 $6,350 single
$12,700 family
Plan Out-of-Pocket
(deductible, coinsurance, medical copays and RX copays)

$6,350 individual
$12,700 family

 $6,350 single
$12,700 family
Preventive Care
(wellness exams, cancer screenings, immunizations)		 $0 $0 50% after deductible
Office Visits
(primary care physician)		 $25 copayment $25 copayment 50% after deductible
Mental/Behavioral Health $25 copayment $25 copayment 50% after deductible
Specialist/Allergist $35 copayment $35 copayment 50% after deductible
Physician Services
(outside of office)		 10% after deductible* 20% after deductible*  50% after deductible
Diagnostic X-Rays and Lab Work 10% after deductible* 20% after deductible* 50% after deductible
Advanced Imaging 
(such as MRI, CAT, PET)		 10% after deductible* 20% after deductible* 50% after deductible
Hospital Emergency Room Services (true emergency) $100 copayment
(waived if admitted)		 $100 copayment
(waived if admitted)

$100 copayment
Urgent Care Facility $35 copayment $35 copayment $35 copayment
Speech Therapy
(limit 30 visits per year)		 $35 copayment $35 copayment 50% after deductible
Physical and Occupational Therapy
(limit 60 visits per year)		 $35 copayment $35 copayment 50% after deductible
Acupuncture
(limit 20 visits per year)		 $35 copayment $35 copayment $35 copayment
Chiropractic Services
(limit 20 visits per year)		 $35 copayment $35 copayment 50% after deductible
Pharmacy-Retail

TIER 1: 10% up to maximum $40 (low-cost generic drugs)

TIER 2: 20% up to maximum $50 (low-cost preferred brands and higher-priced generics)

TIER 3: 20% up to maximum $75 (higher-cost, preferred brand-name drugs)

 50% after deductible
Pharmacy-Specialty Drugs TIER 4: 20% up to maximum $200 (specialty drugs) 50% after deductible

When using a tier 1 or tier 2 free-standing lab or imaging center, you will pay $0.

*$0 after medical out-of-pocket maximum has been met.

**Out-of-network providers may balance bill you for charges in excess of the Usual, Customary, and Reasonable (UCR) fee. You will be responsible for charges in excess of the maximum UCR fee in addition to any applicable deductible, coinsurance or co-payment. Additionally, any amount you pay the provider in excess of the maximum UCR fee will not apply to your out-of-network deductible or out-of-pocket maximum.

Our Mission

Working alongside the various departments and units within 黑料社区, we strive to recruit, cultivate, acknowledge, and involve a diverse pool of talent to fulfill their goals and the overarching goals of the institution.