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
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.
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
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
$30 copayment $60 copayment
Associate + Brand Name
$2,400 $2,400 $4,800
$50 copayment $110 copayment
Family $2,400 $2,400 $4,800 Brand Name
Single $2,000 $2,000 $5,000
The PPO/DRP May Be A Good Option For
$4,000 $4,000 $10,000 You If…
• You want the ability to use the Deductible
$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%
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%
PET, CT, MRI* 10% 20% 40%
$200 $200 $200
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