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For groups of 51-99 employees
- Employees have the lowest out-of-pocket costs when they select designated Performance Plus (PP) in-network providers (WellSpan Health, St. Luke’s University Health Network, Lancaster General Health and Penn State Health).
- A middle tier of benefits applies to Performance Select (PS) in-network providers.
- The highest out-of-pocket costs are incurred when employees use out-of-network providers.
D = Deductible
D/20% = Deductible applies first, then 20% coinsurance
D/$ = Deductible applies first, then a copay
2024 plans
| Plan |
HRA option |
Deductible1 |
Coinsurance |
Out-of-pocket max |
PCP |
Specialist |
Emergency room |
| Performance PPO 1000/0/20 |
No |
PP - $1,000
PS - $2,000
|
PP - 0%
PS - 20%
|
$8,550 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| Performance PPO 3000/0/20 |
Yes |
PP - $3,000
PS - $6,000
|
PP - 0%
PS - 20%
|
$8,550 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| Performance PPO 6000/0/20 |
Yes |
PP -$6,000
PS - $9,000
|
PP - 0%
PS - 20%
|
$9,100 |
PP - $20
PS - $40
|
PP - $40
PS - $60
|
$250 |
| QHDHP Performance PPO 2000/0/02 |
No |
PP - $2,000
PS - $4,000
|
PP - 0%
PS - 20%
|
$7,000 |
PP - D
PS - D/20%
|
PP - D
PS - D/20%
|
D/$250 |
| QHDHP Performance PPO 3500/0/02 |
No |
PP - $3,500
PS - $7,000
|
PP - 0%
PS - 20%
|
$7,500 |
PP - D
PS - D/20%
|
PP - D
PS - D/20%
|
D/$250 |
