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What is a Preferred Provider Network? (PPO)
1. What is a PPO?
PREFERRED PROVIDER ORGANIZATION
ANGELA CARRIER, PRINCIPAL OF FINANCIAL & BENEFIT SERVICES COMPANY
2. Preferred Provider Organization (PPO)
With a PPO plan, employees are encouraged to use a
network of preferred doctors and hospitals.
These providers are contracted to provide service to
plan members at a negotiated or discounted rate.
Employees generally aren't required to designate a
primary care physician, but will have the choice to see
any doctors or specialists within the plans network.
3. PPO Deductible & Copay
Employees have an annual deductible they'll be required to
meet before the insurance company begins covering their
medical bills.
They may also have a copayment for certain services or a
co-insurance where they're responsible for a percentage of
the total charges of their medical expenses.
With a PPO, services rendered outside of the network may
result in a higher out-of-pocket cost.
4. Who Would Like the PPO Option?
A PPO may be a good option for Individuals/families or your
small business if your employees:
Need flexibility when choosing physicians and other
providers
Want the burden of obtaining a referral to see a specialist
Like the balance of greater provider choice versus lower
premiums
5. With a PPO You May Have:
Premium: This is the cost you pay each month for insurance.
Deductible: Some PPOs may have a deductible. You will likely have to
pay a higher deductible if you see an out-of-network doctor.
Copay or coinsurance: A copay is a flat fee, such as $10, that you pay
when you get care. Coinsurance is when you pay a percent of the charges
for care, for example 20%.
Other costs: If your out-of-network doctor charges more than others in
the area do, you may have to pay the balance after your insurance pays
its share.
6. What About
Paperwork?
THERE'S LITTLE TO NO
PAPERWORK WITH A PPO IF
YOU SEE AN IN-NETWORK
DOCTOR.
IF YOU USE AN OUT-OF-
NETWORK PROVIDER, YOU'LL
HAVE TO PAY THE PROVIDER.
THEN YOU HAVE TO FILE A
CLAIM TO GET THE PPO PLAN
TO PAY YOU BACK.
7. “
”
To learn more about a new plan or review of your
existing plan give me a call!
Angela Carrier, Principal
Financial & Benefit Services Company
Email: acarrier@financialandbenefitservices.com
Cell: 724-941-8772