PPO/DRP Medical Plan - Advocate Benefits - Advocate Health Care

PPO/DRP At-A-Glance
Feature How the PPO/DRP Works
When Coverage Begins If you are eligible, coverage for you and your eligible dependents can
begin on the day after you complete 30 days of employment with
Advocate or one of its affiliated companies.
Cost of Coverage You and Advocate share the cost of coverage. Your contributions—
which are based on your length of service as an Advocate associate
and , if you are a full-time associate, your annual pay—are deducted
from your pay on a pre-tax basis.
Choice of Medical Providers You can choose any licensed health care provider. (You will generally
receive a higher level of benefits if you use a participating provider.)
Annual Deductible3 Single
Associate + Child(ren)
Associate + Spouse/Domestic Partner/
Civil Union or Family
Annual Out-of-Pocket Coinsurance Limit4 Individual
Family
Lifetime Benefit Maximum for Infertility
Treatment (not including pharmacy)
In-Network
$1,600
$2,600
$3,200
$2,000
$4,000
Out-of-Network
$3,200
$5,200
$6,400
$5,000
$10,000
$50,000 $50,000
1 When you receive services from Advocate facilities, Advocate will waive 10% of the cost of covered services; you will be responsible for 10%.
You must still satisfy the annual deductible before benefits begin—except for preventive care.
2 When you receive medically necessary care from nonparticipating providers, the PPO/DRP will pay 60% of eligible costs (based on reasonable
and customary charges, according to the applicable reimbursement schedule). You must satisfy a higher annual deductible before benefits
begin and pay higher coinsurance for all services.
3 There are no cost-sharing requirements (e.g., coinsurance, deductibles, and copayments) for preventive care services provided by a
participating provider.
4 Annual out-of-pocket coinsurance limit does not include deductibles, ER copayments, penalties that result from no pre-approval (when
required), and amounts above the maximum allowance when services are received in-network (or the reasonable and customary charge when
services are received out-of-network). Eligible expenses incurred out-of-network apply to the in-network deductible and out-of-pocket limit and
vice versa. No deductible, co-payment or coinsurance aaplies to preventive care services provided by participating providers.
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