When does my PPO deductible start and end?
The deductible is on a calendar year basis, from January 1, to December 31.
Below are some of the questions that are frequently asked by our members, as well as information on more general topics. If you have any questions not addressed in this space please do not hesitate to contact us.
Commonly Prescribed Medications
Specialty Medications
When does my PPO deductible start and end?
Do I have a separate co-payment for lab charges on the PPO plans?
Do emergency room charges apply toward the PPO deductible?
On the PPO plans will x-rays be covered under my office visit co-pays?
Do I have to get a referral on the EPO to see a specialist?
When do my annual dental benefits re-set?
Are Flu Shots Covered on Kaiser?
How do I file an Appeal?
Do I have a separate co-payment for lab charges on the PPO plans?
Yes, the same amount as the office visit co-payment when the lab work is being done by a different provider.
Do emergency room charges apply toward the PPO deductible?
Yes, even if your doctor directs you toward the emergency room.
On the PPO plans will x-rays be covered under my office visit co-pays?
If performed in an office setting and billed with the office visit, then the co-pay would apply. Otherwise it may be subject to your deductible/out of pocket maximum
Do I have to get a referral on the EPO to see a specialist?
No, but you must see a contracted provider.
Relevant Topics
Maternity
PPO – at a contracted provider, there is one office visit co-payment if plan has co-pay. Then charges are paid at the end of the pregnancy, billed on a global basis, subject to the plan deductible and coinsurance.
EPO – office visit co-pay for 1st prenatal visit, then hospital co-pay at the time of delivery.
Newborn
Eligibility: An employee has 30 days from the date of birth to
add a newborn to the plan. The newborn would be covered under CEBT for the
first 30 days, in the absence of other coverage. If the child is
added to another plan, a completed Other Insurance form is needed, as well as
proof of the other coverage.
COBRA
An employee who loses their coverage, unless due to gross misconduct, can continue on COBRA for up to 18 months at their own cost. Dependents losing coverage due to certain qualifying events (i.e. divorce, turning 26) are allowed to continue coverage for up to 36 months. CEBT is partnered with 24HourFlex as the COBRA adminstrator for CEBT products. For more information about COBRA, please click here
Deductible
The following are some, but not all examples of charges that would apply toward the PPO plan deductible.
- X-rays, MRI’s, CT Scans, PET Scans, etc
- Hospital charges (in or out patient)
- Emergency room charges and related providers
- Charges from any non-contracted provider. These charges would be subject to Reasonable & Customary guidelines based on the geographic location of the provider.
- Durable medical equipment.
- Prosthetic devices and orthopedic appliances.