THE LIVINGWELL PPO PLAN

Are you willing to pay more in premiums to limit your out-of-pocket costs to a co-payment for certain services?

The LivingWell PPO may be the plan for you.

• Co-pays apply to doctor’s visits, allergy serum, allergy shots, urgent care centers, and non-speciality prescriptions.

• A emergency room co-pay, plus your deductible, and then co-insurance, will apply when you use an emergency room.

• Your co-pays will not apply to your deductible.

• Your co-pays will apply to your maximum out-of-pocket. Once your out-of-pocket is met, no other co-pays apply.

• Most expenses are subject to the deductible and then covered at 75%.

• There is a zero cost share for specialty drugs for those enrolled in the PrudentRx specialty program. A 30% co-insurance for specialty drugs applies for those not enrolled.

• This plan has two maximum out-of-pocket amounts: one for medical expenses and the other for prescription expenses. They accumulate separately, which means you may pay more out of your pocket depending on your expenses.