Network guide: HMO vs. PPO

To help you make the right choice for you and your family, here's a quick guide to the differences between our HMO and PPO Plus plans.

HMO

  • In-network coverage only
  • Premiums may be lower with HMO plans
  • Your PCP coordinates your care
  • You need referrals for specialty care and certain services

PPO Plus

  • In- and out-of-network coverage
  • Premiums may be higher with PPO plans
  • PCP is recommended but not required
  • No referrals necessary for specialty care

Explore 2024 plans

Complete plans

Complete plans provide full access to our world-class HMO or PPO Plus networks. To view PPO Plus cost sharing for out-of-network providers (PCPs and specialists), check plan details.
 











Plan name Annual Individual Deductible Family Deductible Office Visit Copay - PCP Office Visit Copay - Specialist Plan documents
Complete HMO 20/40 $0 $0 $20 $40
Complete HMO 30/55 $0 $0 $30 $55
Complete HMO 1000 35% $1,000 $2,000 $25 $45
Complete HMO 2000 25/60 II* $2,000 $4,000 $25 $60
Complete HMO 2000 25/60** $2,000 $4,000 $25 $60
Complete HMO HSA 2000 30/60 Enhanced FlexRx** $2,000 $4,000 (D) $30 (D) $60
Complete PPO Plus 2000 25/60** $2,000 $4,000 $25 $60
Complete HMO 2850 $2,850 $5,700 (D) $30 (D) $65
Complete HMO ConnectorCare 0/0* $0 $0 $0 $0
Complete HMO ConnectorCare 0/18* $0 $0 $0 $18
Complete HMO ConnectorCare 0/22* $0 $0 $0 $22

*Available to individuals and families

**Available to small groups

 

 
Select HMO and Select ConnectorCare plans for individuals and families can be found here

Zero cost sharing plan for American Indians and Alaska Natives with incomes up to 300% FPL

Complete HMO $0

Plan overview Benefit details

 

 

Search for covered drugs in our Formulary

See the 6-Tier drug list here.

ConnectorCare members will have the chronic condition medications listed below covered at no cost-sharing.

Hypertension/Coronary artery disease
  • Lisinopril tablets
  • Amlodipine tablets
  • Hydrochlorothiazide/lisinopril tablets
  • Atorvastatin tablets
  • Metoprolol succinate ER tablets
Diabetes
  • Metformin hydrochloride 1000 MG 
  • Metformin hydrochloride 500 MG 
  • Jardiance tablets
  • Insulin
Asthma
  • Albuterol inhalation solution 
  • Budesonide inhalation solution 
  • Montelukast tablets
  • Fluticasone propionate inhaler

 

Looking for past plans?

 

Information about 2024 rate increases

Read information about 2024 rate increases here.

 

Member handbooks and amendments