BENEFIT |
PPO PLAN |
NON-PPO PLAN |
IS APPROVAL (PRIOR AUTHORIZATION) NEEDED? |
Physician Services |
YES |
YES |
SOME |
Prescriptions |
YES |
NO |
SOME |
Hospital (inpatient):
Hospital Room & Board |
YES |
YES |
YES |
YES |
YES |
YES |
Surgery/Anesthesia |
YES |
YES |
YES |
Inpatient Rehabilitation |
YES |
NO |
YES |
Pregnancy/Delivery |
YES |
YES |
UR required for delivery. |
Prenatal Program |
YES |
NO |
Registration required. |
Hospital (outpatient services)
Outpatient X-ray |
YES |
YES |
SOME |
YES |
YES |
SOME |
MRI/CAT Scan/PET Scan |
YES |
NO |
YES |
Outpatient Lab |
YES |
YES |
NO |
Outpatient Surgery |
YES |
NO |
SOME |
Other Outpatient Services |
YES |
YES |
SOME |
Addiction Treatment |
YES |
NO |
YES |
Ambulance Benefit |
YES |
NO |
NO |
Birthing Center |
YES |
YES |
NO |
Chiropractic Care |
YES |
NO |
NO |
Dental |
YES |
YES |
NO |
Durable Medical Equipment |
YES |
NO |
SOME |
Emergency Room |
YES |
YES |
NO |
Home Health Care/Infusion |
YES |
NO |
YES |
Hospice Care |
YES |
NO |
NO |
Medical Supplies |
YES |
NO |
SOME |
Mental Health -Inpatient |
YES |
NO |
YES |
Mental Health - Outpatient |
YES |
NO |
YES |
Therapy (outpatient) |
YES |
NO |
NO |
| Vision |
YES |
NO |
NO |
Hearing Aids |
You can go to any provider you choose. |
