Your Network Health Go PPO Comparison
Customer Service: 800-378-5234
EyeMed link: EyeDocLocator.com
EyeMed Phone: 833-279-4359
Dental Network link: Say Cheese
Dental Network Phone: 888-454-4127
TruHearing: 877-759-8131
Find A Doc: NetworkHealth.com
New Gym Membership Link: YourOnePass.com
Mail Order with Express Scripts: 800-316-3107
For a full listing of the Network Health GO PPO, please click here.
2025
2026
Go
In Network / Out of Network
Go
In Network / Out of Network
Premium
$0
$0
Part B Giveback
$0
$0
Primary Doctor
$0 / $30
$0 / $30
Specialist
$50 / $100
$50 / $100
Physical Therapy
$50 / $100
$50 / $100
Urgent Care
$50
$50
Hospital
$295 days 1-6
$295 days 1-6
Out Of Network
$800 days 1-7
$800 days 1-7
Maximum Out Of Pocket
$3,900 / $6,200
$4,500 / $7,400
Outpatient Surgery
$275 / $225 ASC / $550
$275 / $225 ASC / $550
Ambulance
$275
$275
Emergency
$125
$130
Lab Services
$0-$20 / $40
$0-$20 / $40
X-Rays
$35 / $70
$35 / $70
Complex Diagnostic
$275 / $550
$275 / $550
Durable Medical Equipment
20% / 25%
20% / 25%
Chemo/Part B
20% / 50%
20% / 50%
Part D (Tiers 1-4)
$2 / $8 / 24% / 37%
$0 /$8 / 23% / 25%
90 Day Mail-Order
$0 / $0 / 24% / 37%
$0 / $0 / 23%/ 25%
Part D Deductible
$320
$340
(applies to tiers 2,3,4,5)
(applies to tiers 2,3,4,5)
Hearing Aid
$495 – $1,695
$495 – $1,695
OTC
Pick your Perks ($1,200)
Pick your Perks ($1,155)
Gym Membership
OnePass
One Pass
Dental
Pick your Perks ($1,200)
Pick your Perks ($1,155)
Dental Rider
$45/mo $1,000
$49/mo $1,000
Dental Network
Say Cheese
Say Cheese
Vision
Pick your Perks ($1,200)
Pick your Perks ($1,155)
Your Network Health Go PPO Comparison
2025
2026
Go
In Network / Out of Network
Go
In Network / Out of Network
Premium
$0
$0
Part B Giveback
$0
$0
Primary Doctor
$0 / $30
$0 / $30
Specialist
$50 / $100
$50 / $100
Physical Therapy
$50 / $100
$50 / $100
Urgent Care
$50
$50
Hospital
$295
days 1-6
$295
days 1-6
OON
$800
days 1-7
$800
days 1-7
MOOP Cap
$3,900 / $6,200
$4,500 / $7,400
Outpatient Surg
$275 / $225 ASC / $550
$275 / $225 ASC / $550
Ambulance
$275
$275
Emergency
$125
$130
Lab Services
$0-$20 / $40
$0-$20 / $40
X-Rays
$35 / $70
$35 / $70
Complex Diag
$275 / $550
$275 / $550
DME
20% / 25%
20% / 25%
Chemo/Part B
20% / 50%
20% / 50%
Part D
$2 / $8 / 24% / 37%
$0 / $8 / 23% / 25%
90 Day- Mailorder
$0 / $0 / 24% / 37%
$0 / $0 / 23% / 25%
Part D Ded
$320
$340
| (applies to tiers 2,3,4,5) |
| (applies to tiers 2,3,4,5) |
Hearing Aid
$495-$1,695
$495-$1,695
OTC
Pick your Perks($1,200)
Pick your Perks($1,155)
Gym Membership
One Pass
One Pass
Dental
Pick your Perks($1,200)
Pick your Perks($1,155)
Dental Rider
$45/mo $1,000
$45/mo $1,000
Dental Network
Say Cheese
Say Cheese
Vision
Pick your Perks($1,200)
Pick your Perks($1,155)
Customer Service: 800-378-5234
EyeMed link: EyeDocLocator.com
EyeMed Phone: 833-279-4359
Dental Network link: Say Cheese
Dental Network Phone: 888-454-4127
TruHearing: 877-759-8131
Find A Doc: NetworkHealth.com
New Gym Membership Link: YourOnePass.com
Mail Order with Express Scripts: 800-316-3107
For a full listing of the Network Health GO PPO, please click here.