PPO Summary

Miami's PPO plan offers lower deductibles, coinsurance and set copayments.

See the HDHP plan summary.

Plan Summary Effective January 1, 2020
Service Network Tier 1⇒
Member Pays
Network Tier 2⇒ Member Pays Out-of-Network Benefits
Member Pays**
Calendar Year Deductible $350 individual
$700 family
$5,000 single
$10,000 family
Medical Out-of-Pocket Maximum
(deductible, coinsurance, and medical copays)
$2,100 individual
$4,200 family
$6,350 single
$12,700 family
Plan Out-of-Pocket
(deductible, coinsurance, medical copays and RX copays)

$6,350 individual
$12,700 family

$6,350 single
$12,700 family
Preventive Care
(wellness exams, cancer screenings, immunizations)
$0 $0 50% after deductible
Office Visits
(primary care physician)
$25 copayment $25 copayment 50% after deductible
Mental/Behavioral Health $25 copayment $25 copayment 50% after deductible
Specialist/Allergist $35 copayment $35 copayment 50% after deductible
Physician Services
(outside of office)
10% after deductible* 20% after deductible*  50% after deductible
Diagnostic X-Rays and Lab Work 10% after deductible* 20% after deductible* 50% after deductible
Advanced Imaging 
(such as MRI, CAT, PET)
10% after deductible* 20% after deductible* 50% after deductible
Hospital Emergency Room Services (true emergency) $100 copayment
(waived if admitted)
$100 copayment
(waived if admitted)

$100 copayment

Urgent Care Facility $35 copayment $35 copayment $35 copayment
Speech Therapy
(limit 30 visits per year)
$35 copayment $35 copayment 50% after deductible
Physical and Occupational Therapy
(limit 60 visits per year)
$35 copayment $35 copayment 50% after deductible
Acupuncture
(limit 20 visits per year)
$35 copayment $35 copayment $35 copayment
Chiropractic Services
(limit 20 visits per year)
$35 copayment $35 copayment 50% after deductible
Pharmacy-Retail $10, $35, $60 50% after deductible
Pharmacy-Specialty Drugs $100 50% after deductible
Pharmacy-Mail Order
90-day Supply
$20/$70/$120
(Specialty drugs limited to 30-day supply)
Not Covered

When using a tier 1 or tier 2 free-standing lab or imaging center, you will pay $0.

*$0 after medical out-of-pocket maximum has been met.

**Out-of-network providers may balance bill you for charges in excess of the Usual, Customary, and Reasonable (UCR) fee. You will be responsible for charges in excess of the maximum UCR fee in addition to any applicable deductible, coinsurance or co-payment. Additionally, any amount you pay the provider in excess of the maximum UCR fee will not apply to your out-of-network deductible or out-of-pocket maximum.