PPO Health Plans
Preferred Provider Organization Plans - PPO Plans, Coverage, &
What is PPO insurance? That is a question many have been asking themselves.
The PPO health plan is an increasingly common type of managed care
health insurance. Such plans consist of a a group of providers. These
groups include doctors, hospitals, and even medical labs. PPO plans
are more flexible than HMOs, but there are some similarities: a nearly
unlimited amount of health care services are covered, in exchange
for a monthly premium. In addition, PPO health insurance plans normally
include an annual deductible. This deductible represents the amount
you must pay out-of-pocket before medical coverage kicks in. Co-payments
ranging from $10 to $30 per service count towards it.
A PPO health insurance plan allows you to see any doctor of your choice,
allowing you more control. Visits are most affordable if you stay
within the network of physicians that work with your PPO medical plan.
PPO plans are able to offer services at a reduced rate because of
the increased patient volume brought by the network, meaning that
you will only owe a small co-pay. Unlike other types of managed care,
you will still receive partial reimbursement if you choose an out-of-network
You will have to shoulder more of the cost than you would if you saw
an in-network physician, and you may be required to file claims yourself
in order for PPO plans to pay part of the bill.
HMO Health Plans
Health Maintenance Organizations (HMO)
When your health care coverage is provided by a Health Maintenance
Organization, you typically must select an HMO physician to be your
primary health care provider. This doctor will coordinate all of your
medical care, including referrals to specialists, such as a dermatologist,
cardiologist or surgeon. If you choose to seek treatment from a non-network
physician, you will generally be required to pay most of the cost
yourself. By law, an HMO cannot require referrals for emergency care,
so an HMO will pay for emergency room treatment without a referral.
Due to the restriction of choosing from mostly HMO network services,
it's important to check the physician listing and hospital affiliations
for the HMO you are considering. If the list is extensive and you
are satisfied with the hospitals used by the HMO network, an HMO may
be a good choice. On average, HMOs are the least expensive health
option for employers and employees. Doctor's visits, preventive care,
and medical treatment are covered by your monthly insurance premium,
and there is no individual or family deductible to meet. There is
generally a co-payment for each visit that varies based on the type
of service provided and the plan you select, but typically no co-insurance.
Most standard HMO plans do not have a lifetime maximum benefit amount.
Some HMOs are starting to offer more choices in plan configuration,
allowing their members to visit preferred providers outside of the
network. This gives their members access to an HMO network and a PPO
network at the same time, although the PPO portion usually involves
deductibles and co-insurance.
POS Health Plans
Point-of-Service Plan (POS)
The POS plan is like a combination of the HMO and PPO plans. You are
required to designate an in-network physician to be your primary health
care provider. You may go out-of-network if you choose, but in doing
so, you will have to pay most of the cost yourself, unless a primary
care physician refers you to that specific doctor. In that instance,
the health plan will pay all or most of your bill. Depending on the
networks available in your area, a POS plan may be a great choice
for your small business, if your employees work in multiple cities
with different groups of doctors and hospitals available to them.
for more health insurance articles!
Questions or comments? Please let us know.