PPO Conversion Plan

HMSA’s PPO Conversion Plan allows you and your family to continue your HMSA medical coverage after leaving HMSA group coverage.

The plan includes an annual deductible of $2,000 per member or $4,000 for a family. This means that every calendar year, the eligible expenses you pay will be applied toward meeting the deductible. Once the annual deductible is met, the plan pays 80 percent of HMSA's eligible charge for most services when using a participating provider. For services such as physician visits, ground ambulance service, emergency room visits, and diabetic supplies, you will pay a predictable, fixed dollar copayment.

The PPO Conversion Plan’s annual maximum copayment provides another level of financial protection. The annual maximum copayment is $3,000 per member and $6,000 for family coverage. Once you pay the annual maximum copayment amount for eligible expenses, including the deductible, the plan pays 100 percent of HMSA's eligible charges for covered services, up to a lifetime maximum amount of $5 million. If you ever meet the lifetime maximum, the plan continues to pay $10,000 per year as long as you continue to be a member covered under this plan.

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