The PPO Deductible Reimbursement Plan (PPO/DRP):

	Provides $600 (if you elect single coverage) and $1,200 (if you elect another coverage level) to be used to satisfy the $1,000 individual/$2,000 family annual deductibles.
	Pays the full cost—100%—of preventive care services for both physicians and facilities with no deductible for in network providers… removing any financial concerns that may have kept you from getting preventive care services in the past.
	Pays 80% of the cost of network services or 60% of the cost of non-network services, once you’ve met the deductible.
	Pays the full cost—100%—of covered medical services once your share of the cost of these services (the amounts you pay in deductible and coinsurance) reaches an annual out-of-pocket expense maximum… limiting the total amount you would ever have to pay in any year.
	Offers a savings advantage—a Deductible Reimbursement Account (DRA)… providing you tax-free dollars from Advocate that you can use to pay eligible out-of-pocket medical expenses throughout the year as these expenses are applied against your annual deductible.

There are two PPO/DRP options; these two options are identical except that one (the CoreSourcePPO/DRP) is administered by CoreSource and provides you access to the CoreSource provider network (starting January 1, 2010, the Aetna Signature Administrators providers network), while the other one (the HumanaPPO/DRP) is administered by Humana and provides you access to the Humana provider network. (This is the only difference between these two PPO/DRP coverage options, but it is an important factor to take into account if you are interested in PPO/DRP coverage.)

Like any PPO coverage option, these two options offer two levels of coverage based on whether you use participating or nonparticipating providers:

	When you use participating providers—you receive maximum benefits and reduce your out-of-pocket costs.
	When you use nonparticipating providers—your benefits are lower, your out-of-pocket costs are higher and there are claim forms to file.

	Do you prefer to pay a set amount when you see your doctor? In the PPO/DRPs you pay a coinsurance fee, which is a percentage of the total cost of the service. In the HMO you pay a set copayment for most services,
	Do you mind paying a deductible before benefits are paid? In the PPO/DRPs you must meet an annual deductible before benefits are paid. In the HMO there is no deductible to meet before benefits begin (though a copayment does apply to most covered services).
	Do you need flexibility in terms of which physicians you can see? In the PPO/DRPs, you can see any doctor you choose, but benefits are payable at different levels depending on whether the doctor is a member of the PPO's network of participating providers. In the HMO, you must select a primary care physician (PCP), who then coordinates all of your care, including care provided by a specialist. Benefits are only payable if you see your PCP and other HMO physicians to which your PCP provides a referral.

	Non-duplication of benefits applies
	You must first pay the annual deductible amounts before coverage begins for all services except prescription drugs and preventive benefits (to which the deductible does not apply).
	Preventive benefits include those listed under Preventive benefits in PPO/DRP and HDHP Covered Services.
	If you elect family coverage, two deductible amounts must be satisfied. However, these deductible amounts can be satisfied through a combination of medical expenses for all covered members of your family. This is known as an aggregate deductible.
	A new deductible must be satisfied each calendar year.
	Hospital emergency room copayments cannot be used toward your annual deductibles or maximum out-of-pocket expense amounts.
	Annual deductibles, charges in excess of reasonable and customary charges, and pharmacy copayments will not apply toward your maximum out-of-pocket expense limits.
	Your portion of reasonable and customary charges will be applied equally toward satisfying participating and non-participating deductibles and maximum out-of-pocket expense amounts.

Example:
Let's assume:

	You enroll for single coverage in either the CoreSourcePPO/DRP or HumanaPPO/DRP.
	You receive $3,000 in covered services during the year, including $1,000 in preventive services.

Here’s how your PPO/DRP coverage will work if you receive all services from network providers vs. if you receive all services from nonparticipating providers.

* Amount applied from Advocate contributions to your Deductible Reimbursement Account (DRA).

Additional information:

When you have the opportunity to use an Advocate facility, Advocate will waive one-half of the amount you would otherwise pay (10% of the total charge). This waiver will not apply to emergency room copayments, nor will it apply to the charges of non-Advocate facilities