Health

PPO

View 2021 Enable Midstream Benefit Rates 

 

With the PPO Plan, you pay copays for prescription drugs and visits to in-network doctor's offices, urgent care clinics and emergency rooms. For other care, you meet a deductible  and then pay coinsurance until you meet your out-of-pocket maximum. Keep in mind your co-pays on the PPO plan do not count towards the deductible, but they do count towards the out-of-pocket maximum.

 

2021 Summary of Benefits & Coverage 

2020 Summary of Benefits & Coverage 

 

Service In-Network* Out-of-Network*
Deductible

$750 Individual

$1,500 Family**

$1,500 Individual

3,000 Family**

Enable Contribution HSA or FSA

N/A
Coinsurance

Plan pays 80%

You pay 20%

Plan pays 55%

You pay 45%

Out-of-Pocket Maximum

$3,000 Individual

$7,500 Family**

$7,500 Individual

$18,750 Family**

Preventive Care Covered at 100% 45% after deductible
Primary Care Office Visit $25 copay

45% after deductible

Specialist Office Visit

$40 copay

45% after deductible

Urgent Care

$75 copay

45% after deductible

Emergency Room

20% after deductible plus a $250 copay. If you are admitted to the hospital, the $250 copay is waived 

45% after deductible plus a $250 copay. If you are admitted to the hospital, you receive in-network benefits (you meet your in-network deductible and pay 20% coinsurance).

Hospitalization

20% after deductible 

45% after deductible 

MDLIVE

$10 copay

N/A

MDLIVE - Behavioral Health

$10 copay

N/A

Prescription Drugs

You receive pharmacy benefits whether or not you've met your deductible.

Pharmacy-filled Generic
(34-day supply)

$10 copay

45% after deductible 

Pharmacy-filled Preferred
(34-day supply)

$35 copay

45% after deductible  

Pharmacy-filled Non-Preferred
(34-day supply)
$60 copay

45% after deductible 

Mail-ordered/Smart90 Generic
(90-day supply)

$20 copay

N/A

Mail-ordered/Smart90 Preferred
(90-day supply)

$70 copay N/A
Mail-ordered/Smart90 Non-Preferred
(90-day supply)
$120 copay N/A

 

*In-network and out-of-network deductibles are separate. Only in-network services apply toward your in-network deductible, and only out-of-network services apply to your out-of-network deductible.

** Family coverage includes employee + spouse, employee + child(ren), and employee + family

HDHP and PPO Plan Comparison

Plan Detail HDHP PPO

 

In-Network

In-Network

Deductible*

$1,500 Employee only

$3,000 Family**

$750 Individual

$1,500 Family**

Enable Contribution

HSA or FSA

$500 Employee Only

$1,000 Family**

N/A

Coinsurance

(after deductible)

Plan pays 90%

You pay 10%

Plan pays 80%

Plan pays 20%

Out-of-Pocket Maximum

$4,000 Individual

$8,000 Family**

$3,000 Individual

$7,500 Family**

Preventive Care

Covered at 100%

Covered at 100%

Primary Care Office Visit

10% after deductible

$25 copay

Specialist office visit

10% after deductible

$40 copay

Urgent Care

10% after deductible

$75 copay

Emergency Room

10% after deductible

20% after deductible plus a $250 copay.

If admitted to the hospital, the $250 copay is waived

Hospitalization

10% after deductible

20% after deductible

MDLIVE

$44 per visit until you meet your deductible, then 10%

$10 copay

MDLIVE - Behavioral health

$85-$175 per visit depending on the services received until you meet your deductible, then 10%

$10 copay

Pharmacy-filled

Generic (34-day supply)

$10 copay after deductible

$10 copay

Pharmacy-filled Preferred/Formulary

(34-day supply)

$25 copay after deductible

$35 copay

Pharmacy-filled Non-Preferred/Formulary

(34-day supply)

$45 copay after deductible

$60 copay

Mail-ordered/Smart90

Generic (90-day supply)

20% after deductible

$20 copay

Mail-ordered/Smart90

Preferred/Formulary (90-day supply)

20% after deductible

$70 copay

Mail-ordered/Smart90

Non-Preffered/Non-Formulary (90-day supply)

20% after deductible

$120 copay

 

*In-network and out-of-network deductibles are seperate. Only in-network services apply toward your in-network deductible, and only out-of-network servcies apply to your out-of-network deductible

** Family coverage includes employee + spouse, employee + child(ren), and employee + family

 

For detailed plan information, visit the Plan Documents page on the HUB. You may also request a copy of the plan document by contacting the HR Service Center at 844-687-4748 (844-OUR-HR4U) or HR@enablemidstream.com.

ENROLLMENT POLICY

The information on this site is intended to summarize your 2021 Enable Midstream benefits. Not all plan provisions, limitations or exclusions are described in this publication. In case of a conflict between the information provided in this summary and the actual plan documents and insurance contracts, the plan documents and insurance contracts will govern. The plan sponsors have the right to change or terminate benefits at any time.

If you have questions about enrollment or your benefits, you can contact our HR Service Center at 844-687-4748 (844-OUR-HR4U) or HR@EnableMidstream.com.