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Office of Group Insurance. What is a PPO?. PPO Basics. A Preferred Provider Organization (PPO) is a Health P lan W ith an Established P rovider N etwork that has Agreed to Accept S pecific P ayment L evels for Specific S ervices. The PPO is not a Health Maintenance Organization (HMO).
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Office of Group Insurance What is a PPO?
PPO Basics • A Preferred Provider Organization (PPO) is a Health Plan With an Established Provider Network that has Agreed to Accept Specific Payment Levels for Specific Services. • The PPO is not a Health Maintenance Organization (HMO).
What Are the Benefits? • Patients can “Self-Refer” Themselves to Specialists. • In a PPO, you are Free to Select any Health Care Provider. • Lower Deductibles, Higher Reimbursement, and the Lowest Possible Out-of-Pocket Expense.
FY2012 PPO Plans • Pharmacy, Dental, and Vision Benefits are Unchanged. • A New Premium Category has been added. • The FSA Limit has Been Increased, along with the IBHP In/Out-Patient Co-Payments. • Enhanced Wellness Benefits and Well Baby Nursery Benefits.
FY2012 Traditional Plans • Employee Premiums Will Increase by 15%. • Traditional Plan Benefits are Unchanged. • Co-Insurance is Unchanged at 80/20 of Allowable Charges.
How Do the Plans Differ? • The PPO Plan Network is Slightly Smaller than the Traditional Network. • Monthly Premiums are Less than the Current FY2011 Traditional Insurance Plan. • The Co-Payment is $20 for Physician Office Exams. • Co-Insurance is 85/15 of Allowable Charges In-Network and 70/30 Out-of-Network.
