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80/20 PPO Plan

Boeing Employee Benefits

    • No Personal Care Provider (PCP) required
    • Nationwide network of providers
    • Benefits for preventive care
 

Coverage at a Glance

Deductible: $175 individual; $525 family
Annual OOP Max: $2,000 individual; $4,000 family
Lifetime Max: $1,500,000 individual
Copay: $15 office visit; $50 emergency room
Coinsurance: 20% network; 40% non-network
Network(s): PPO Network
   
Yes Preventive Care
Yes Hospital Services
Yes Emergency Room
Yes Mental Health
Yes Substance Abuse
Yes Alternative Care
Yes Prescription benefits
Yes Vision
Yes BlueCard®
 

Basic Features

Deductibles:
  • $175 individual
  • $525 family
Annual OOP Max:
  • $2,000 individual
  • $4,000 family
Lifetime Max:
  • $1,500,000 individual
Coinsurance:
  • 20% network
  • 40% non-network
Preventive Care:
  • 100% network. No copay required. Not subject to deductible.
  • Non-network care is not covered
Office Visits:
  • 80% network after $15 copay. Not subject to deductible.
  • 60% non-network. Subject to deductible.
Diagnostic x-ray and
Laboratory Services:
  • 80% network
  • 60% non-network
  • Subject to deductible
Hospital Services:
  • 80% network
  • 60% non-network
  • Subject to deductible
Emergency Room:
  • 80% network and non-network after $50 copay
  • Subject to deductible
  • Emergency room treatment is paid at the network level when the condition meets the definition of a medical emergency. Refer to the Summary Plan Description below for more information.
Mental Health:
  • Inpatient: 90% network (subject to deductible); 50% non-network (limited to 20 days per benefit year and subject to deductible)
  • Outpatient: 80% network after $15 copay (subject to deductible); 50% non-network (limited to 20 visits per benefit year and subject to deductible)
  • To receive benefits for mental health treatment, you must contact the Boeing Helpline (ValueOptions) at 1 (800) 892-1411.
Substance Abuse:
  • Inpatient: 80% network (subject to substance abuse deductible); 50% non-network (limited to 20 days per benefit year and subject to substance abuse deductible)
  • Outpatient: 80% network after $15 copay (subject to substance abuse deductible); 50% non-network (limited to 20 visits per benefit year and subject to substance abuse deductible)
  • To receive benefits for substance abuse treatment, you must contact the Boeing Helpline (ValueOptions) at 1 (800) 892-1411.
Alternative care:
  • 80% network after $15 copay (not subject to deductible); 60% non-network (subject to deductible)
  • Limited 26 spinal and extremity manipulations per benefit year
  • Limited to 10 acupuncture visits per benefit year
  • Alternative care under the 80/20 PPO Plan includes services received by acupuncturists, a licensed M.D. or D.O., and chiropractors only. Naturopaths, naturopathic services and massage therapists are not covered under this plan.
Prescriptions:
  • Generic: $5 retail copay; $10 mail-order copay
  • Brand-name formulary: $15 retail copay; $30 mail-order copay
  • Non-formulary: $30 retail copay; $60 mail-order copay
  • Not subject to deductible
  • Prescription medications are covered through a prescription program managed by Medco. Contact Medco at 1 (800) 841-2797 or visit the Medco Web site to learn more.
Vision:
  • Routine vision care services are covered through Vision Service Plan (VSP). Contact VSP at 1 (800) 877-7195 or visit the VSP Web site to learn more.

Benefit Summary

To view, save, or print a copy of the Benefit Summary, you will require Adobe® Acrobat® Reader. If you do not have Acrobat® Reader, you can download a free copy from Adobe®.

Summary Plan Description

For specific benefit information, refer to the Summary Plan Description located on The Boeing Company Web site.

This information is provided as confirmation of benefits available under the 80/20 PPO Plan for Boeing employees, early retirees, and their families and should not be construed as a guarantee of coverage for any services. The final determination on all claims is made upon their submittal to the plan.

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