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PPO Plans
Health Alliance Custom Choice PPO plans combine the best features of HMO coverage (comprehensive benefits and preventive care) with the best features of major medical insurance (flexibility) to provide you with quality health coverage in the most cost-effective manner. Custom Choice PPO is cost-effective because Health Alliance arranges for discounts with its "preferred providers" and offers higher rates of coverage and savings to members who choose them. You always have the option of obtaining services from any non-preferred physician of your choice; however, your out-of-pocket costs will be higher when you see a non-preferred physician. Your coverage will always be higher and your costs will be lower when you choose a preferred provider.

Although we recommend that PPO members establish a relationship with a Primary Care Physician (a family practitioner, general practitioner or internist), Custom Choice PPO plans do not require you to select one. When you have a health-related problem that requires specialty care, we feel it is always best to contact your personal or primary physician first, as he or she will make sure you are referred to the appropriate specialist.

Standard PPO
Our Standard PPO plans offer a lower-cost alternative to more comprehensive PPO plans. These plans feature coverage for the basic services you need, like visits to the doctor and emergencies.

With a Standard PPO plan, you automatically receive Tier 1 outpatient prescription drug coverage. This means you'll be covered for the generic drugs you use most. (view the Health Alliance Standard Drug List for a complete listing of drugs.)

Our most common Custom Choice PPO plans are summarized below. Click on the plan name for plan details.

	PPO 80/50	PPO 90/50	PPO 90/70	PPO 100/50	Standard PPO
Office Visit	$25	$25	$15	$25	20%
ER Visit	$150	$175	$150	$175	$175
Percent of Other Preferred Covered Services paid by Health Alliance*	80%	90%	90%	100%	80%
Percent of Other Non-Preferred Covered Services paid by Health Alliance*	50%	50%	70%	50%	50%

*after annual deductible is met

Reasonable and Customary Limitations
If you receive care from a non-preferred provider, coverage is limited to reasonable and customary charges. This means if your physician charges a higher rate than what appears on the reasonable and customary fee schedule, you will be responsible for 100 percent of the difference in addition to the applicable coinsurance. If, however, you obtain care from a preferred provider, the reasonable and customary policy does not apply. In this case, you will only be responsible for the applicable coinsurance.

Choose Your Costs
You can customize your PPO plan by selecting a deductible and out-of-pocket maximum combination that best fits your budget and medical needs.

For PPO plans 80/50, 90/50 and 90/70, you may choose any of the deductible/out-of-pocket maximum combinations from the charts below (A-F). For PPO 100/50, you may choose between the next two options (G or H). This is another way to customize your coverage-the higher the deductible you choose, the lower your monthly premium will be.

	Deductible				Out-of-Pocket-Maximum

	In-Network		Out-of-Network		In-Network		Out-of-Network
	Single	Family	Single	Family	Single	Family	Single	Family
A.	$250	$500	$500	$1,000	$1,750	$3,500	$3,500	$7,000
B.	$500	$1,000	$1,000	$2,000	$2,000	$4,000	$4,000	$8,000
C.	$750	$1,500	$1,500	$3,000	$3,250	$6,500	$6,500	$13,000
D.	$1,000	$2,000	$2,000	$4,000	$3,500	$7,000	$7,000	$14,000
E.	$1,500	$3,000	$3,000	$6,000	$4,000	$8,000	$8,000	$16,000
F.	$2,000	$4,000	$4,000	$8,000	$4,500	$9,000	$9,000	$18,000
PPO 100/50 members choose one option below only
G.	$1,500	$3,000	$3,000	$6,000	$1,500	$3,000	$8,000	$16,000
H.	$3,000	$6,000	$6,000	$12,000	$3,000	$6,000	$11,000	$22,000
For a lower-cost option with the most basic coverage, try our Standard PPO plans. Choose from the following set of deductible/out-of-pocket maximum combinations (I-L).
Standard PPO members choose one option below only
I.	$500	$1,000	$1,000	$2,000	$1,500	$3,000	$3,000	$6,000
J.	$1,000	$2,000	$2,000	$4,000	$3,000	$6,000	$6,000	$12,000
K.	$2,000	$4,000	$4,000	$8,000	$6,000	$12,000	$12,000	$24,000
L.	$5,000	$10,000	$10,000	$20,000	$15,000	$30,000	$30,000	$60,000

Another Custom Choice-Rx Coverage*
You can add pharmacy benefits, including oral contraceptives, to Custom Choice PPO (summarized below). This coverage is available for an additional premium amount.

Click here to see the Health Alliance standard drug list.

Rx Option 1:
$100 deductible.
Tier 1: $7 copayment for generic drugs
Tier 2: 30% coinsurance for brand-name, preferred drugs
Tier 3: 50% coinsurance for brand-name, non-preferred drugs

Rx Option 2:
No deductible.
Tier 1: $15 copayment for generic drugs
Tier 2: $30 copayment for brand-name, preferred drugs
Tier 3: $50 copayment for brand-name, non-preferred drugs
(For Rx Plan 2, Out-of-Pocket Maximum is $1,500. After Out-of-Pocket Maximum is reached, copayments are waived for Tiers 1 and 2, but only waived for Tier 3 drugs if there is a medical reason the member must have the Tier 3 drug.)

*Note: Rx Option 1 and Rx Option 2 are not available with Standard PPO plans. The following prescription coverage is automatically included with Standard PPO plans:

	In-Network	Out-of-Network
Tier 1 Outpatient Prescription Drugs*	$20	50%

*Copayments or coinsurance do not apply to the out-of-pocket maximum or deductible.

Qualified High-Deductible Health Plans (QHDHPs)
Health Alliance also offers qualified, high-deductible health plans (QHDHPs). With these plans, you enjoy the flexibility of our PPO benefit design, and when you couple it with a Health Savings Account through the financial institution of your choice, your qualified expenses are tax-free. For your convenience, Health Alliance contracts with Benefit Planning Consultants, Inc. (BPC) to serve as an option for your HSA provider. BPC has three banks to choose from and the set-up fee is waived for Health Alliance members.

Plus, you earn interest on the money you don't spend. QHDHP deductibles range from the government minimum to $5,000 (single). Preventive care is not subject to the deductible, meaning you get first-dollar coverage for those important, routine services. In addition, all of our QHDHPs also include pharmacy coverage, and you can select whether to add maternity coverage.

You can also customize your QHDHP by selecting a Deductible and Out-of-Pocket Maximum combination that best fits your budget and medical needs. You may choose any of the deductible/out-of-pocket maximum combinations from the charts below. The higher the deductible you choose, the lower your monthly premium will be.

Deductible					Coinsurance		Out-of-Pocket Maximum

In-Network		Out-of-Network		In-Network		Out-of-Network		In-Network		Out-of-Network
Single	Family	Single	Family					Single	Family	Single	Family
$1,150	$2,300	$2,300	$4,600	0%		50%		$1,150	$2,300	$6,900	$13,800
$1,150	$2,300	$2,300	$4,600	20%		40%		$3,450	$6,900	$6,900	$13,800
$1,500	$3,000	$3,000	$6,000	0%		50%		$1,500	$3,000	$8,000	$16,000
$1,500	$3,000	$3,000	$6,000	20%		40%		$4,000	$8,000	$8,000	$16,000
$2,000	$4,000	$4,000	$8,000	0%		50%		$2,000	$4,000	$10,000	$20,000
$2,000	$4,000	$4,000	$8,000	20%		40%		$5,000	$10,000	$10,000	$20,000
$3,000	$6,000	$6,000	$12,000	0%		50%		$3,000	$6,000	$10,000	$20,000
$5,000	$10,000	$10,000	$20,000	0%		50%		$5,000	$10,000	$15,000	$30,000

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All contents © 2003 Health Alliance Medical Plans. All rights reserved. Every effort has been made to ensure that this information is accurate. It is not intended to replace the legal source. In case of any discrepancy between this information and the legal source, the legal source will govern in all cases.

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