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.