Understanding definitions and how they impact each plan
(Full definitions of all terms used in the following chart are included below. This content is available in an alternative format here.)
Payroll or Premium Contribution
The health care payroll or premium contribution for both plans is calculated as a percentage of each employee’s annual salary. Members of the Teamsters’ Union have different payroll contribution rates as per their contract.
A deductible is the set dollar amount that members pay for non-preventive care expenses – such as doctor’s visits related to sickness or injury. The deductible must be met before insurance starts to pay a portion of health care costs.
Ultimately, the amount each individual or family will pay for these services depends on three things:
- Selected plan (PPO Plan or PPO Savings)
- Enrollment tier (which indicates which or how many family members are on the plan. The tiers include individual; two-person; parent & child(ren); and family).
- Use of in-network or out-of-network health care providers. Out-of-network providers will cost more.
With both the PPO Plan and PPO Savings Plan, once the deductible has been met for the year, Penn State pays 90 percent of claims and faculty and staff pay the remaining 10 percent.
When a person’s coinsurance payments reach the out-of-pocket maximum for that year, any remaining claims for that year are paid by Penn State at 100 percent.
A copayment is a fixed payment that a plan member pays each time they (or family members covered by their plan) receive medical care. Copayments do not count toward deductibles. The PPO Plan has copayments, while the PPO Savings Plan only has deductibles and coinsurance.
Note: The $20 PPO Plan copayment is waived for Penn State employees and their insured dependents who visit a Centre County Hershey Medical Group Provider for a primary care office visit. To see a list of Hershey Medical Group providers in the University Park area, go to http://ohr.psu.edu/pshmg/.