This PPO plan includes a HRA in which Excelligence contributes money for you to use for eligible medical expenses. Unlike other health care accounts, only your Excelligence can put money in your HRA. Each time you visit the doctor or receive health care services, you can use the tax-free funds in your HRA. The HRA covers incurred expenses by paying them from this allocation until the contribution dollars are exhausted.
| 2025 HRA Plan Rates | ||||||
|---|---|---|---|---|---|---|
| Salary <$50,000 | Salary $50,000 - $100,000 | Salary >$100,000 | ||||
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee Only | $41.69 | $83.39 | $42.81 | $85.62 | $42.81 | $85.62 |
| Employee + Spouse | $114.44 | $228.87 | $154.15 | $308.30 | $159.88 | $319.75 |
| Employee + Child(ren) | $93.63 | $187.26 | $126.12 | $252.24 | $130.81 | $261.62 |
| Employee + Family | $161.25 | $322.49 | $217.20 | $434.41 | $225.28 | $450.56 |
| PPO with HRA Information | ||
|---|---|---|
| Excelligence contributes to your HRA, up to $1,000 for employee only coverage and $2,000 for a family coverage to be used towards eligible medical expenses. | ||
| In Network | Out Of Network | |
| General Services | ||
| Annual Deductible/Individual | $3,000 | $9,000 |
| Annual Deductible/Family | $6,000 | $18,000 |
| Annual Out-of-Pocket Limit/Individual | $6,000 | $15,000 |
| Annual Out-of-Pocket Limit/Family | $12,000 | $30,000 |
| Office Services | ||
| Co Pays |
$30 - Primary Care, Urgent Care and Chiropractic $40 - Specialty Visit |
50% After Deductible |
| Office Visit/Exam | 30% After Deductible | 50% After Deductible |
| Virtual Visits | $0 Copy | |
| Specialist Visit | 30% After Deductible | 50% After Deductible |
| Urgent Care | 30% After Deductible | 50% After Deductible |
| Preventative Services | 100% Covered | 100% Covered |
| Hospital Services | ||
| Inpatient Hospital | 30% After Deductible | 50% After Deductible |
| Outpatient Surgery | 30% After Deductible | 50% After Deductible |
| Emergency Room | 30% After Deductible | 50% After Deductible |
Along the way, you may also be required to pay a fixed amount – or copay – each time you see a provider.
