The new high-deductible PPO plan contains some similarities to and some differences with the current PPO plan. The main similarity is the freedom to choose your own doctors both inside and outside of the Tufts network.
The differences include the fact that the high-deductible PPO has a larger up-front deductible, but almost no copayments once the annual deductible for medical services has been satisfied; however, prescriptions continue to have copayments.
The high-deductible plan is accompanied by a health savings account (HSA) that allows you to put money aside, before income taxes, to pay for all of your medical expenses using pre-tax dollars.
An HSA allows dollars to "roll over" from one year to the next and provides tax advantages: contributions are made before income taxes, balances grow tax-free, and all withdrawals for qualified medical expenses are tax-free. The tables below offer a quick comparison of the PPO plan and the high-deductible PPO plan, as well as a look at some of the kinds of expenses that you may have to cover out-of-pocket prior to meeting the higher deductible of the new high-deductible PPO plan.
For more information about the HSA, visit WageWorks.
|In-Network (Tufts Providers)||Out-of-Network (Non- Tufts Providers|
|Deductible||Individual $1,500, Family $3,000|
|Preventive Care||Covered in Full||20% Coinsurance; No Deductible|
|Annual Physical||Covered in Full||20% Coinsurance; No Deductible|
|Office Visit||Covered in Full after Deductible||20% Coinsurance after Deductible|
|Routine Vision Exam||$25 Copayment, 1 Every 12 Months with||20% Coinsurance after Deductible|
|Emergency Room||Covered in Full after Deductible||Deductible|
|Inpatient Hospital||Covered in Full after Deductible||20% Coinsurance after Deductible|
|Copayment Maximum||Individual $5,000, Family $10,000||Individual $5,000, Family $10,000|
|Prescription Drugs (in/out of Network)||No Tiers|
|Deductible applies, then copays of $15-$50|
Speciality Drugs (in-Network only) - Special pricing may apply