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Put the choice of better health care in your client's hands with our new Lovelace PPO plan.
This means you can work with your clients on tailoring exciting new plan offers for families, employers and
employees with more choice, more control and greater flexibility than traditional HMOs. That means members
can choose their physicians or specialists "In, or Out-of-Network" and can determine access to care that fits
both their needs and their budget. Choose the plan that offers extraordinary flexibility of premiums and
complementary disease management & wellness programs designed to keep your employees healthy.
Choose the new Lovelace PPO plan.
YOU'RE GOING TO LOVE OUR PPO
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Health Insurance that will give you the coverage you need head to toe.
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Affordable care including diagnostic tests, Mammograms, & Colonoscopies at
affordable co-pays.
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The flexibility to let you choose doctors you want to see, gives you choice in
who provides your care.
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A variety of deductibles & co-insurance amounts allow you to work within a budget
without sacrificing care.
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A wellness program that is proven to keep you on track with a healthy lifestyle at
no extra charge.
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Preventive care with no annual dollar maximums or limitations on number of visits.
What is a PPO?
A Preferred Provider Organization is
a health care organization/product composed of a network (physicians, hospitals, or other providers) which provides
health care services at a reduced premium. PPOs may also offer more flexibility by allowing for visits to out-of-network
professionals at a greater expense to the member. Visits within the network require the payment of a smaller fee.
There is often a deductible for out-of network expenses and a higher co-payment.
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| added value programs |
healthy steps
personal health assessment |
baby love |
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ASSESS YOUR CURRENT HEALTH STATUS & OVERALL HEALTH
Our Healthy Steps
Personal Health Assessment (PHA) allows you to assess your current health status and provides help in making health changes.
You can find the Lovelace Healthy Steps Personal Health Assessment at lovelacehealthplan.com.
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SUPPORT YOUR BABY'S HEALTH BY LEARNING MORE
Baby Love is a resource for women with Lovelace insurance. It is included in your benefits
at no extra charge. This program provides pregnant women with phone advice and educational materials specific
to their pregnancy. Enrolling in Baby Love is easy. Call 505.727.BABY (2229).
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healthy trails
HELP YOUR KIDS GROW UP STRONG & HEALTHY
Healthy Trails is designed to help parents track the growth and development of their
children from birth all the way through their 18th birthday. During Healthy Trails visits, the doctor will
make sure your child gets the care he or she needs.
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healthy steps coaching
SUPPORT DECISIONS ABOUT VARIOUS TREATMENT
OPTIONS & PROVIDE DISEASE MANAGEMENT SERVICES
Our personal Healthy
Steps Coaches can help you when you are confronted with decisions about treatment options for certain conditions such as
breast and prostate conditions, back, knee and hip pain, heart disease, and many more. They will also provide disease
management coaching services for you if you have a chronic condition like diabetes, asthma, heart disease or lung disease.
The coaches will provide tools to help you manage your condition from day to day and guide and support you in setting
realistic goals to make healthy lifestyle changes. Bilingual coaches are always ready to assist you if needed.
Our Healthy Steps
Coaches are available 24/7 to provide you with health information and support for all your health care needs.
They can even help you prepare for your visit with your doctor. Call 800.390.9159 to speak to a coach or communicate
online at lovelacehealthplan.com.
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s.t.o.p.
STOP TOBACCO FOR OPTIMAL PREVENTION
The S.T.O.P.Program offers individualized phone-counseling sessions at no cost to you.
A registered nurse helps you set up a personalized quit plan.
healthy weight
HELP TO ACHIEVE & MAINTAIN A HEALTHY WEIGHT
Healthy Weight is a 10-week telephone counseling program that focuses on lifestyle
change. It is designed to help people
develop the knowledge and skills needed to achieve and
maintain a healthy weight.
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Covered Services and Benefit Description
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Member's Cost
Co-Payments or Coinsurance
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In-Network
Participating
Provider
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Out -of -Network
Non-Participating
Provider
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Annual
Deductible
Options
(1)
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Per individual, per calendar year.
In-Network: Family deductible is two times individual amount chosen.
Out-of-Network: Family deductible is two and a half (2.5) times
the individual amount chosen. $250 - $7,500 $500 - $15,000
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$250 - $7,500 |
$500 - $15,000
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Annual Out-of-
Pocket Limit
Options
(2)
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Per individual, per calendar year.
Includes core medical coinsurance amounts only, does not include deductible, co-payments, penalty amounts,
or non-covered charges.
In-Network: Family limit is two times individual amount chosen.
Out-of-Network: Family limit is two and a half (2.5) times the individual amount chosen.
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$2,000 - $15,000
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$4,000 - $30,000
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Medical Office
Visits |
Services rendered in an office setting.
Covered services include:
Annual physicals
Adult & Child
Immunizations
Health and Family Planning
Well Baby/Child care
Diabetic Care Services
Prenatal/Postnatal care
Vision and Hearing Screening (for members age 17
and under)
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In-network visits not
subject to Deductible
Non-Specialist
$20-$40
co-pay/visit
Specialist
$40-$60
co-pay/visit
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30% - 50%
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Non-Surgical
Diagnostic Tests,
Labs & Imaging
Services |
Services provided for laboratory tests, non-surgical diagnostic
testing, mammograms and X-Rays |
No additional charge; included with
co-pay for applicable
visit/facility charge |
30% - 50%
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Outpatient
Surgical &
Medical Services |
Services provided in an outpatient facility setting,
including:
Outpatient/Ambulatory surgery
Administration of Injections
and Infusions
Transfusion of Blood
Radiation therapy and
Chemotherapy
Dialysis (member must apply for Medicare
benefits)
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10% - 30%
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30% - 50%
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| MRI/CT/PET |
Outpatient Medically Necessary imaging tests |
10% - 30%
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30% - 50%
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Colonoscopy &
Endoscopic
Procedures |
Exams, tests and procedures |
$40 - $60
co-pay/visit |
30% - 50%
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Worldwide
Emergency &
Urgent Care |
Emergency Room Visit |
10% - 30% initial treatment
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| Urgent Care Visit |
10% - 30%
follow-up care |
30% - 50%
follow-up care |
Inpatient
Hospital
Services |
Medical/Surgical services provided during an admission to an Inpatient facility,
including:
Semiprivate Room and Board
Physician, Surgeon and
Anesthesiologist Charges
Operating and Recovery Room
Drugs and Medications
Long-term Acute Care
Maternity Related Room and Board and Covered
Ancillaries (including Routine Nursery Care for
Covered Newborns) (3)
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10% - 30%
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30% - 50% |
(1) Deductible must be met before benefit payments are made, unless otherwise noted. Additionally,
the In-network and Out-of-Network deductibles are separate. Payments to In-network services contribute to the
In-Network deductible only. Payments made to Out-of-Network services contribute to the Out-of Network deductible only.
(2) After a member reaches the applicable out-of-pocket limit, Plan pays 100% of most of the covered In-network
and Out-of-Network charges. Please refer to your EOC for details. The In-network and Out-of-Network maximums are
separate. Payments to In-Network services contribute to the In-Network maximum only. Payments made to Out-of-Network
services contribute to the Out-of-Network maximum only.
(3) Newborn child is covered from birth only if enrolled
within 31 days. Please refer to your EOC Handbook for enrollment information.
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Classic PPO Plan Details
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 Classic PPO $20/10%/30%/$500 Plan |
Classic PPO $25/10%/30%/$1,500 Plan |
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Classic PPO $20/10%/30%/$1,000 Plan |
Classic PPO $25/10%/30%/$2,000 Plan |
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Classic PPO $20/10%/30%/$1,500 Plan |
Classic PPO $25/20%/40%/$250 Plan |
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Classic PPO $20/10%/30%/$2,000 Plan |
Classic PPO $25/20%/40%/$500 Plan |
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Classic PPO $20/20%/40%/$250 Plan |
Classic PPO $25/20%/40%/$1000 Plan |
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Classic PPO $20/20%/40%/$500 Plan |
Classic PPO $25/20%/40%/$1,500 Plan |
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Classic PPO $20/20%/40%/$1,000 Plan |
Classic PPO $25/20%/40%/$2,000 Plan |
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Classic PPO $20/20%/40%/$1,500 Plan |
Classic PPO $25/20%/40%/$2,500 Plan |
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Classic PPO $20/20%/40%/$2,000 Plan |
Classic PPO $25/20%/40%/$5,000 Plan |
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Classic PPO $20/20%/40%/$2,500 Plan |
Classic PPO $25/20%/40%/$7,500 Plan |
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Classic PPO $20/20%/40%/$5,000 Plan |
Classic PPO $30/30%/40%/$500 Plan |
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Classic PPO $20/20%/40%/$7,500 Plan |
Classic PPO $30/30%/40%/$2,500 Plan |
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Classic PPO $20/20%/50%/$500 Plan |
Classic PPO $35/30%/40%/$1,000 Plan |
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Classic PPO $20/20%/50%/$1,000 Plan |
Classic PPO $35/30%/40%/$4,000 Plan |
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Classic PPO $20/20%/50%/$2,000 Plan |
Classic PPO $40/30%/40%/$1,500 Plan |
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Classic PPO $20/20%/50%/$2,500 Plan |
Classic PPO $40/30%/40%/$2,000 Plan |
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Classic PPO $25/10%/30%/$500 Plan |
Classic PPO $40/30%/40%/$5,000 Plan |
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Classic PPO $25/10%/30%/$1,000 Plan |
Classic PPO $40/30%/40%/$7,500 Plan |
For more information about our new PPO products, please contact your Sales or Service Representative.
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