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Traditional PPO Plan

Boeing Employee Benefits

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

Coverage at a Glance

Deductible: Separate deductibles for network/non-network. Refer to Benefit Summary below.
Annual OOP Max: Separate annual OOP for network/non-network. Refer to Benefit Summary below.
Lifetime Max: $1,500,000; $2,000,000 individual
Copay: $50; $75 emergency room only
Coinsurance: 10% 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:
  • $250 - $300 individual; $750 - $900 family (network)
  • $500 - $600 individual; $1,500 - $1,800 family (non-network)
Annual OOP Max:
  • $2,000 individual; $4,000 family (network)
  • $4,000 individual; $8,000 family (non-network)
Lifetime Max:
  • $1,500,000; $2,000,000 individual
Coinsurance:
  • 10% network
  • 40% non-network
Preventive Care:
  • 90%-100% network. Not subject to deductible.
  • Non-network care is not covered
Office Visits:
  • 90% network
  • 60% non-network
  • Subject to deductible
Diagnostic x-ray and
Laboratory Services:
  • 90% network (unless specified otherwise)
  • 60% non-network
  • Subject to deductible
Hospital Services:
  • 90% network
  • 60% non-network
  • Subject to deductible
Emergency Room:
  • 90% network and non-network
  • $50; $75 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 (not subject to deductible); 60% non-network (limited to 20 days per benefit year and subject to deductible)
  • Outpatient: 90% network (not subject to deductible); 60% 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: 90% network (not subject to deductible); 60% non-network (subject to deductible)
  • Outpatient: 90% network (not subject to deductible); 60% non-network (subject to deductible)
  • To receive benefits for substance abuse treatment, you must contact the Boeing Helpline (ValueOptions) at 1 (800) 892-1411.
Alternative care:
  • 90% network; 60% non-network
  • Subject to deductible.
  • Limited to a combined total of 26 spinal and extremity manipulation visits per benefit year.
  • Alternative care under the Traditional PPO Plan includes services received by acupuncturists 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: $20 retail copay; $40 mail-order copay
  • Non-formulary: $35 retail copay; $70 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 active employees, refer to the Summary Plan Description located on The Boeing Company Web site for specific benefit information. For early retirees, refer to the Boeing TotalAccess Web site (requires BEMS ID or SSN and PIN).

This information is provided as confirmation of benefits available under the Traditional 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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