2017 PPO 800

About the PPO 800

This medical plan option is available almost everywhere in the U.S. except Hawaii. Additional plans may be available depending on where you live. See your 2017 medical plans by state.

Depending on the state you live in, the PPO 800 plan is administered by either Aetna or UnitedHealthcare, but the plan works the same:

  • Medical coverage includes prescription drug benefits, mental health and substance abuse benefits, access to Teladoc and Expert Medical Opinion.
  • You can choose to see any doctor or other provider you like, but you will pay less when you see a PPO in-network provider, because they have agreed to charge lower, negotiated rates. Note: Mental health and substance abuse benefits are administered by Beacon Health Options. If you have any questions about your mental health and substance abuse coverage, or if pre-certification/notification is required, contact the Behavioral Health Claims Administrator, Beacon Health Options, at 1-877-888-6440.
  • The plan pays 100 percent for covered in-network preventive care, such as annual physicals, age-based screenings and specialized services for children and women. Preventive care guidelines are updated by the government on a regular basis. If you have questions about what is considered preventive care services, contact the health plan number on the back of your ID card.
  • In-network, you pay a $15 copay for visits to your primary care physician (PCP). You pay $10 per visit at Well at Dell Health Centers, and you pay a $10 copay to use Teledoc, virtual doctor.
  • You pay an $8 copay for generic prescription drugs and 30 percent coinsurance for brand-name formulary drugs ($40 minimum, $90 maximum). Non-formulary drugs are not covered.
  • For other services, you must pay the annual deductible before the plan begins to pay benefits.
  • Once you reach your annual deductible, the plan pays 80 percent of most in-network eligible expenses and you pay 20 percent (called “coinsurance”) until you reach your out-of-pocket maximum. Note: The coinsurance is 80 percent for outpatient diagnostic lab and high-tech radiology (MRI and CT scans) at in-network freestanding facilities and 60 percent at a hospital or hospital affiliated facility. See Coverage for high-tech radiology and lab services for more details.
  • Once you reach the out-of-pocket maximum for the year, the plan pays 100 percent of eligible in-network expenses for the rest of the year. There is a separate out-of-pocket maximum for prescription drugs under the PPO 800 plan.

For more information on the PPO 800, see the Summary Plan Descriptions on Your Benefits Resources website @ Work | Log in). From Your Benefits Resources home page, go to the Knowledge Center.

Remember: If you have questions about your benefits, contact the Dell Benefits Center at 1-888-335-5663, option 1, option 1.

Key features of the PPO 800

This table highlights the key benefit features of the PPO 800 (benefits are shown for in-network services):

 

Primary care physician
office visit

$15 copay per visit.
$10 per visit at Well at Health Centers (Round Rock, Parmer, Plano).

Specialist copay
(see below for more info)

$60 for Aetna Aexcel® specialist or UHC Premium® providers (or if not in area served by these providers).
$80 for non-Aetna Aexcel specialists or UHC Premium providers.

Teladoc

$10 copay per visit.

Non-emergency, non-preventive diagnostic lab work and radiology services (such as MRIs and CAT scans)

  • In-network preferred facility (like a Quest Diagnostics® lab for Aetna or a LabCorp  lab for UnitedHealthcare) covered at 80% of cost after deductible
  • In-network, non-preferred facility (like a hospital lab) covered at 60% of cost after deductible

Annual deductible

Individual:   $800
Family:        $1,600

How you meet the deductible

  • Only medical expenses (including mental health and substance abuse) count toward the deductible. There is no deductible on prescription drugs.
  • Each covered person pays toward his or her own individual deductible before the plan begins to pay for that individual. Once combined expenses for all covered individuals equals the family deductible, the plan begins to pay for all family members (including those who haven’t yet met their individual deductible).

Out-of-pocket maximums (includes deductibles and expenses at Well at Dell Health Centers)

Medical:
You only: $4,000
Family: $8,000

Prescription drug:
You only: $1,500
Family: $1,500 per person, capped at $4,500 per family

How you reach the out-of-pocket maximum

Expenses for each covered person count toward his or her own individual out-of-pocket maximum before the plan begins to pay 100% of eligible expenses for the rest of the year for that individual.
  • If you cover only yourself, that amount is $4,000.
  • If you cover dependents, once any one family member reaches the $4,000 individual limit, the plan pays 100% of that individual’s medical costs for the remainder of the year. Once the combined expenses for all covered individuals reach the family limit of $8,000, the plan pays 100% of eligible medical expenses for all covered family members (including those who haven’t yet met their individual limit).

Prescription drugs in the PPO 800

The PPO 800 includes prescription drug coverage. Learn how prescription drug coverage works.

What if I'm Medicare eligible?

See how medical coverage is affected when you become eligible for Medicare. Learn more.

More details

About primary care physicians (PCPs)

Your PCP is the physician you work with to manage your routine health care needs and who acts as an advisor in the event you need more specialized care. Don’t have a PCP? Now is a great time to find one and start establishing a relationship with him or her. To find a network PCP, visit Castlight, go to your carrier’s website or call the NurseLine at 1-866-WELL-DELL or 1-866-935-5335. You can chat with the NurseLine online at the WebMD website (@ Work | Log in ).

Specialist visits

Many team members have access to high-performing specialists through either the Aetna Aexcel® network or the UnitedHealth Premium® program. These specialists (like cardiologists, endocrinologists, etc.) are selected based on the quality of care they provide — measured by treatment outcomes, rates of hospital readmission, and other factors, including cost efficiency.

Your specialist copay will be $60 when you choose a participating specialist, but your copay will be $80 if you choose not to use a high-performing participating specialist.

For specialties outside the program or if the program isn’t available to you, your copay will be $60.

These programs are not yet available to all team members everywhere, but it’s always in your best interest to find a high-quality provider.

Learn More About the Aexcel Network. To find an Aexcel network specialist, look for a star () next to the name.

Learn More About UnitedHealth Premium. To find a UnitedHealth Premium specialist, look for the (tier1) designation next to the name.

Coverage levels for high-tech radiology and lab services

The PPO 800 plan pays different levels of benefits for non-emergency, non-preventive diagnostic lab work and radiology services, such as MRIs and CAT scans, depending on the facility chosen. If you need help finding preferred network facilities that offer the highest coverage, contact the health plan number on the back of your ID card.

 

If you use an:

The plan pays:

In-network preferred facility (like a Quest Diagnostics® lab for Aetna or a LabCorp® lab for UnitedHealthcare)

80% of cost after deductible

In-network, non-preferred facility (like a hospital lab)

60% of cost after deductible

Out-of-network facility

50% of eligible cost after deductible

Important: In-network preventive care services are covered at 100 percent. Emergency radiology and lab diagnostics and all tests performed during in-network hospitalization are covered at 80 percent after deductible.

Find an Aetna Preferred Facility.
Find a UnitedHealthcare Preferred Facility.

Mental health and substance abuse benefits

To access these benefits, you and your eligible dependents must be enrolled in a Dell medical plan through Aetna or UnitedHealthcare. The mental health program is administered by Beacon Health Options.* If you have any questions about your mental health and substance abuse coverage, or if pre-certification/notification is required, contact Beacon Health Options, at 1-877-888-6440 or visit achievesolutions.net/Dell.

Inpatient and outpatient mental health and substance abuse treatment is covered the same as similar inpatient and outpatient medical services under the medical plans.

  • The copay for inpatient medical care is waived for inpatient mental health and/or substance abuse treatment (in-network).
  • The copay for outpatient mental health and/or substance abuse office visits (in-network) is $15 per visit.
  • Any deductibles you pay for mental health and substance abuse treatment apply to your medical plan’s deductible and out-of-pocket maximum. Only inpatient mental health and substance abuse treatment is subject to a deductible and coinsurance.
  • Copays for outpatient mental health and substance abuse treatment apply to the out-of-pocket maximum, but do not apply toward the deductible.

There are no annual visit limits or lifetime maximum limits for outpatient office visits.

Applied Behavior Analysis (ABA) therapy is covered for participants with a diagnosis of autism spectrum disorder. “ABA therapy,” when medically appropriate, can help those diagnosed with autism spectrum disorder learn how to communicate better, develop relationships, play, care for themselves, learn in school, succeed at work and participate fully and productively in family and community life. This benefit, administered by Beacon Health Options, includes a network of ABA providers, full care management services and claims payment for authorized ABA services.

ABA therapy is in addition to mental health/substance abuse and Employee Assistance Program (EAP) benefits.

*If you’re covered by the Aetna International, Kaiser Permanente POS (Hawaii only), Kaiser Permanente HMO (California only), or Harvard Pilgrim medical plan, mental health and substance abuse benefits are administered by your medical plan. See your 2017 medical plans by state.