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Office of Group Insurance. What’s a PPO?. VSI. 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. PPO Benefits.
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Office of Group Insurance What’s a PPO? VSI
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.
PPO Benefits • Patients can “Self-Refer” themselves to a specialist. • Referrals are not required • If your physician is in the PPO network, you will have: • Lower deductibles, higher reimbursement, and the lowest possible out-of-pocket expense.
FY2012 Traditional Plans • Co-insurance is unchanged at 80/20 of allowable charges. • The insurance carrier pays for 80% of the allowable charges. • Employee premiums will increase by 15% • Traditional plan benefits are uncharged.
How Are They Different? • 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 for in-network physicians. • Co-Insurance is 85/15 of allowable charges In-network and 70/30 out-of-network.
