PPODRP Highlights

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  January 2010

The Deductible Reimbursement Plan (PPO/DRP) is a PPO,              How the PPO/DRPWorks
with a tax-free retirement medical savings advantage that          1. Advocate contributes $600 for single coverage and
provides you with “first-dollar” coverage. When you choose            $1,200 for all other coverage levels to your Deductible
a PPO/DRP plan you pay nothing out of pocket for the                  Reimbursement Account.
first $600 of incurred deductible medical expenses if you
                                                                   2. During benefits enrollment, you may elect to suspend your
elect single coverage or $1,200 if you elect any other level
                                                                      Advocate Deductible Reimbursement Account contribution
of coverage.
                                                                      for medical expenses and save this money for retirement.
The PPO/DRP option:                                                   This means that your entire contribution will automatically
                                                                      roll over to a Healthe Futures Account on April 1 of the
•	 Has an Advocate-funded Deductible Reimbursement                    following year.
   Account (DRA) of $600 for single coverage/$1,200 for all
   other coverage levels to provide you with “first dollar”          Although there are many advantages to saving these funds
   coverage for your deductible expenses.                            for the future, it’s important to know that if you suspend
                                                                     your account, these funds will not be available during the
•	 Provides 100% coverage for preventive care.                       current plan year to pay for expenses you may incur. This
•	 Has an annual deductible of:                                      means that as you incur expenses throughout the year,
                                                                     you will be responsible for meeting your deductible either
 – $1,200 – for single coverage
                                                                     out-of-pocket or through a Health Care Flexible Spending
 – $2,200 – for associate + child(ren) coverage                      Account (Health Care FSA). The suspend feature is a
                                                                     one-time annual election that may not be changed after
 – $2,400 – for either associate + spouse/domestic partner
                                                                     November 30th, the end of the enrollment period.
   (DP) or family coverage
                                                                   3. If you do not suspend your Advocate Deductible
•	 Provides the opportunity to save the funds in your
                                                                      Reimbursement Account contribution, you can choose to
   Deductible Reimbursement Account for medical
                                                                      use the funds in your account to pay eligible expenses or
   expenses during retirement by electing to suspend these
                                                                      pay these expenses out of your own pocket.
   funds during benefits enrollment.

•	 Provides prescription drug coverage (subject to                   Preventive care is 100% covered in the PPO/DRP, so
   copayments) under the Advocate Prescription                       you will have no costs for receiving these services.
   Benefits Program.
                                                                   4. After you have used the funds in your Deductible
•	 Offers choice of Coresource or Humana for network
                                                                      Reimbursement Account, you are responsible for
   and administration. Note: Starting January 1, 2010,
                                                                      100% of your medical costs until you meet the annual
   the provider network for the CoreSourcePPO/DRP is
                                                                      deductible, which is based on your coverage level. Keep
   Aetna Signature AdministratorsSM.
                                                                      in mind, that if you use your Deductible Reimbursement
Starting January 1, 2010, eligible associates and                     Account funds, the most you will pay out of pocket
spouses (or domestic partners) can complete a Succeed                 before meeting the deductible is $600 for single
questionnaire and then be eligible to earn valuable                   coverage, and $1,000 for associate + child(ren) coverage
financial incentives including:                                       or $1,200 for associate + spouse/DP or family coverage.
•	 $200 each that can be added to their Deductible                 5. After meeting the annual deductible, you pay
   Reimbursement Account balance for the year, and                    coinsurance until you reach your out-of-pocket
•	 Other Healthe Rewards for participating in                         maximum of $2,000 for single coverage or $4,000 for
   healthy activities.                                                family coverage.
6. Once you reach the out-of-pocket maximum, all of your                         Prescription Drug Benefits
   medical costs are covered at 100% by the plan.                                Prescription drug benefits under a PPO/DRP option
7. If you have unused funds in your Deductible                                   are covered under the Advocate Prescription Benefits
   Reimbursement Account at the end of the year, they                            Program, which is administered by CVS/Caremark.
   will automatically roll over into your Healthe Futures                        Benefits are provided for prescription drugs purchased at
   Account (HFA) to help you save for medical expenses                           retail pharmacies in the CVS/Caremark network or through
   during retirement.                                                            CVS/Caremark’s mail order program. To find a pharmacy
                                                                                 in the CVS/Caremark network or use the mail order
PPO/DRP Highlights                                                               program, go to www.caremark.com.

                        At Advocate                            Out-of-                     Prescription Drug Benefit Costs
     Features              Facility        In-Network          Network
                                                                                                        Retail             Mail
Deductible                                                                            Type          (up to 30-day     (up to 90-day
 Single                     $1,200            $1,200            $2,400                                 supply)           supply)
 Associate +                                                                     Generic           $15 copayment     $25 copayment
                            $2,200            $2,200            $4,400
 Child(ren)                                                                      Preferred
                                                                                                   $30 copayment     $60 copayment
 Associate +                                                                     Brand Name
                            $2,400            $2,400            $4,800
 Spouse/DP                                                                       Non-preferred
                                                                                                   $50 copayment    $110 copayment
 Family                     $2,400            $2,400            $4,800           Brand Name
Out-of-Pocket Maximum
 Single                     $2,000            $2,000            $5,000
                                                                                 The PPO/DRP May Be A Good Option For
 Associate +
                            $4,000            $4,000           $10,000           You If…
                                                                                 •	 You want the ability to use the Deductible
 Associate +
                            $4,000            $4,000           $10,000              Reimbursement Account to save and pay for medical
 Family                     $4,000            $4,000           $10,000              expenses tax-free during retirement.
                            100%              100%                               •	 You want to use your Deductible Reimbursement
Preventive Care                                                  40%
                           covered           covered
                                                                                    Account to provide “first dollar coverage.”
Office Visits                20%               20%               40%
Lab and X-Rays                                                                   •	 You are comfortable with paying—and have the
 Doctor’s Office             20%               20%               40%
                                                                                    ability to pay—out-of-pocket expenses that exceed
                                                                                    Advocate’s contributions to your Deductible
 Lab*                        10%               20%               40%
                                                                                    Reimbursement Account.
 PET, CT, MRI*               10%               20%               40%
                           $200              $200              $200
Emergency Room
                         Copayment         Copayment         Copayment           For More Information
Visits                                                                           More details are available at www.advocateinfoexpress.
                            10%              20%               40%
Hospitalizations                                                                 com (click on Advocate Benefits Online). Specific
 Inpatient*                  10%               20%               40%             questions can also be directed to Advocate InfoExpress
 Outpatient*                 10%               20%               40%             at 800.775.4784.
Behavioral Health (care must be precertified)
 Inpatient                   10%               20%               40%
 Outpatient                  10%               20%               40%
                         Unlimited*        $1,000,000        $1,000,000
  All benefits except preventive care are subject to the deductible first.
  * When charged as an Advocate facility charge

                                                                             2                                       © Advocate Health Care   11/09

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