Page 7 - 2021 Miami Marlins Front Office Benefits Guide
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MEDICAL COVERAGE 90/70 PPO
90/70 PPO
Plan Provision In-Network Out-of-Network
Annual Deductible
1
Individual $250 $500
Family $500 $1,000
Out-of-Pocket Maximum (Excludes Deductible)
Individual $1,500 $3,600
Family $3,000 $6,000
Lifetime Maximum Unlimited
Preventive Care 100% Not Covered
Primary Physician Office Visit 100% after $15 Copay 70% after Deductible
Specialist Office Visit 100% after $15 Copay 70% after Deductible
X-Ray and Lab 100% after $15 Copay 70% after Deductible
Inpatient Hospital Services 90% after Deductible 70% after Deductible
Outpatient Hospital Services 90% after Deductible 70% after Deductible
Urgent Care 100% after $15 Copay 70% after Deductible
Emergency Room Care 100% after $150 Copay (waived if admitted)
Telemedicine Services 100% after $15 Copay Not Covered
The above is a brief summary of this benefit option.
Click here for more detailed information on this available benefit option.
1 For those enrolled as a family under the HDHP, the family deductible and out-of-pocket maximums apply to the family on a combined basis.
Note: This is a summary only of your coverage. In-network services are based on negotiated charges; out-of-network services are based on reasonable
and customary (R&C) charges.
Miami Marlins Front Office Employee Benefit Guide Page 7
