Guide PPO

With straightforward cost-sharing and proactive, year-round guidance from Collective Health’s team
of experts, the Guide PPO plan is designed with your health in mind. This medical plan is designed to make it easy to determine what you can expect to pay for your healthcare, and allow you to pay less for care associated with better health outcomes.

Simplified Cost-Sharing
There are two kinds of cost-sharing arrangements built into most medical benefit plans that determine how much you will pay out-of-pocket for a given service:

Copay

A copay is a fixed amount that you'll pay for covered health care services or products (think medications, office visits, etc.).

Coinsurance

After you've met your deductible, you'll pay a percentage of the cost for some health care services and products. Keep in mind that the percentage you'll owe will vary based on what services or product you're getting (i.e., you'll pay different amounts for procedures, medications, office visits, etc.).

While there are both copays and coinsurances built into the Guide PPO plan, you’ll pay a copay for the majority of the most frequently used services. Again, copays allow you to know what you’ll owe before you go (and, they aren’t subject to your deductible).

Important Benefits to Know
The Guide PPO has a few unique features that will impact what you pay for your care.

Additional Benefits That Are Free for You

Healthcare experts have identified certain services that are associated with better health outcomes. Some of these services are available to you for free on your Guide PPO plan as long as you stay in-network:

Glucometers

& testing strips

An at-home blood test (via a finger prick!) to monitor blood glucose levels for the purpose of diabetes management.

Lipid testing

A blood test to help determine whether you may benefit from cholesterol medications to prevent heart disease.

Hemoglobin A1C testing

A blood test to diagnoseand manage prediabetes and diabetes.

INR testing

A blood test to manage your response to blood-thinners and reduce your risk of heart attack, stroke, and blood clotting.

Pulmonary rehabilitation

A treatment regimen to improve lung function and reduce symptoms associated with chronic lung disease.

Cardiac rehabilitation

A treatment regimen to improve heart health and promote recovery after an acute cardiac event.

Peak flow meters

A handheld device to help monitor and manage asthma.

Blood pressure monitors

A device to help monitor your blood pressure between office visits.

Benefits with higher coinsurance

Healthcare experts have similarly identified some services that may present more risks than benefits, or have newer or better alternatives.

Spinal fusions
Spinal injections
Vertebroplasty
Kyphoplasty
Asymptomatic renal artery angioplasty or stenting
Knee arthroscopy
Proton beam for prostate cancer
IMRT
In-lab sleep studies
Subset of back imaging

If you plan to have any of the above services performed this year and have questions about your coverage, please reach out to the Collective Health Member Advocates at (844) 803-0209.

Advanced Imaging
Did you know that a MRI that costs $300 at a non-hospital based, “freestanding” imaging centers can cost up to $3,000 at an outpatient hospital? For people that have to pay a coinsurance, or a percentage of that amount, that can come as an unwelcome surprise. We’re taking the guesswork out of it with simplified copays.

For advanced imaging (like CT/PET scans, MRIs) at a freestanding imaging center, you’ll pay $50 (as long as it’s in-network). For advanced imaging at an in-network, hospital-based imaging center, you’ll pay $500.

To find a freestanding imaging center near you, you can use Collective Health’s Cost Information tool, available on your Collective Health web account and app, or call the Collective Health Member Advocates at (844) 803-0209.

Emergency Room
In emergency situations, we’ve got you covered. For your first 1-2 visits to the Emergency Room, you’ll pay a $200 copay. For visits 3+, you’ll pay a $500 copay each time. In 2025, the copay for ER visits will all be $200. For urgent, but non-emergency situations, there are cheaper, more convenient care options. The following benefits are available when you need care fast, and will only cost you $10:

Office visits at One Medical (including scheduled, remote visits)*
Urgent care

To find a One Medical location or an urgent care near you, you can use Collective Health’s Get Care tool, available on your Collective Health web account and app or reach out to Collective Health Member Advocates.

*On-demand, video chats through the One Medical app are free.