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HSA Plan

Network

20% coinsurance after deductible

Non-Network

Not covered

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

Not covered

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

Not covered

Infusions are covered when received through a network provider. Medications (specialty and non-specialty) that can be safely obtained through a pharmacy, and which may be self-administered, are not a medical plan benefit. These medications are covered as part of the pharmacy benefit.

Preauthorization is required for all chemotherapy for cancer diagnosis.


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