What is a PPO?
PPO Plans from Health Insurance Plus
PPOs At-a-Glance
With a PPO plan you are retaining more risk, and buying less insurance than you are
with an HMO.
Positives
- Lower monthly premium than HMO’s
- Better doctor selection than HMO’s
- More Flexability on medical services
Negatives
- Higher out of pocket costs
- Reduced wellness benefits coverage
- Labs, Tests, and X-ray have a deductible
Popular Individual PPO Plans
A Preferred Provider Organization (PPO) encourages its members to use the insurance
company's network of participating doctors and hospitals. Each doctor and health
care provider contracts with the insurance company to provide services at a discounted
rate. Members are not required to pick a primary care physician, and they may see
specialists at their own discretion.
PPOs usually have an annual deductible, an amount you must spend on health costs
before the insurance coverage pays your claims. Once the deductible is met, you
will still pay a co-payment for doctor appointments and a percentage for other health
costs until you meet the maximum out-of-pocket limit. At that time, the plan covers
all costs.
How does a PPO Plan work?
PPOs offer both in-network and out-of-network coverage. In-network doctors and providers
have contracted with the insurance providers for lower rates. Out-of-network doctors
have not contracted with the insurance providers. Because of this, the patient will
pay substantially more for out-of-network services than in-network. The patient
may also have to pay an out-of-network doctor up front and submit a claim for reimbursement.
While PPOs offer significantly more flexibility in selecting doctors and other providers,
it's a good idea to check with your favorite doctor or local hospital. Make sure
that they have contracted with the PPO so your visits are covered. It's also a good
idea to review the plan's benefits for preventative and well-child care, to see
if it meets your needs.
Plan Types
