Early Retiree Meritain Health PPO

The PPO plan allows both in-network and out-of-network services with a $400 individual/$800 family deductible for in-network services and a $800 individual/$1600 family deductible for out-of-network services. The family deductible may not be satisfied by any one family member. Once the deductible has been satisfied, in-network services are covered at 85% and out-of-network services at 65%. Once the maximum out-of-pocket is satisfied the plan pays 100% of eligible charges. In-network out-of-pocket maximums are $1,950 for an individual and $4,600 for a family. Out-of-network out-of-pocket maximums are $3,900 for an individual and $7,800 for a family. This plan also provides coverage nationwide. The plan does not require participants to choose a primary care physician, but rather offers the flexibility of visiting both in-network and out-of-network physicians.

Retirees are able to choose which local network/hospital they would like to participate in as their in-network service provider. The two network choices are Select Network/St. Joseph Regional Medical Center OR Community Health Alliance (CHA)/Memorial Hospital.

The national network for the PPO plan is Private Healthcare Systems (PHCS) – Healthy Directions, and a list of participating providers is available at www.phcs.com.

The mental health network for the PPO plan is New Avenues Behavioral Health Network. For a list of participating providers, please visit their web site at www.newavenuesonline.com. To request a printed copy of the directory from the Office of Human Resources email askhr@nd.edu or call 631-9396.

Claim information can be obtained through Meritain Health’s web site at www.meritain.com.

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