With the PPO option, you have higher premiums, but you benefit from lower, more predictable expenses when you seek care.
Here's how it works (2025 information):
- You will pay any cost sharing specified on the Schedule of Benefits each time you seek medical care — like visiting a doctor or going to urgent care.
- Finally, if you reach the maximum amount for paying out of pocket, $4,500 individual / $9,000 family (includes medical and prescription), then your eligible medical expenses are completely covered by SmartHealth for the remainder of the year, when you receive care within the Ascension Network.
- The deductible for the PPO plan option is per individual, up to the family deductible. This means one person can meet the individual deductible for coinsurance or the out-of-pocket maximum to apply, even if you are enrolled in family coverage. The single deductible is embedded in the family deductible, so no one family member can contribute more than the single amount toward the family deductible.
- Different deductibles, coinsurance and out-of-pocket maximum amounts apply when you use National Network or out-of-network providers and facilities.
What's Covered
- Compare costs based on the provider network in a side-by-side chart: (View 2024) (View 2025)
- Compare key features of each plan and the payroll deductions. (View Medical Plan Options on page)
- You can also view the Summary Plan Description for more information.
To review how costs are shared, visit the Summary of Benefits and Coverage page for each plan option.
Note: Different deductibles, coinsurance and out-of-pocket maximum amounts apply when you use National Network or out-of-network providers and facilities.
Rx Costs and PPO
If you choose the PPO option, your prescription cost is based upon the type of medication you use. If you select a generic medication or a specialty drug, you will pay a copay. If you fill your prescription with a brand drug (preferred or non-preferred), you pay coinsurance.
The copay and coinsurance amounts count toward your out-of-pocket maximum. Once you reach your out-of-pocket maximum, your prescriptions are covered 100% for the remainder of the year.
The SmartHealth Flexible Copay program identifies coupons and patient assistance provided by the medication's manufacturer. Your copays may be reduced at preferred pharmacies for flexible copay medications. However, these coupons and manufacturer's patient assistance will not apply to your out-of-pocket costs for the year with the PPO copay option.
Health Accounts and PPO
If you enroll in the PPO option, you can also enroll in a healthcare flexible spending account (FSA) to pay for your copays. If you enroll in the PPO option, you can also enroll in a healthcare flexible spending account (FSA) to pay for your copays. Learn more.