A Preferred Provider Organization (PPO) provides members with the ultimate freedom of choice, as well as an opportunity to reduce costs and administrative work.

Like a Point of Service plan, PPO members are not required to choose a PCP. They can see any doctor, whether that doctor participates with the PPO plan or not.

If the doctor participates in a network, the member receives a higher level of coverage, has lower or no deductibles, no claim forms and less out-of-pocket expense. If the member chooses a doctor who does not participate in the PPO network, he or she receives a lower level of coverage.

The member will incur more costs and need to fill out claim forms. However, the choice belongs to the member!

PPO Characteristics

• No primary care physician is needed to coordinate care.
• A network exists, as does freedom of choice.
• There is a flexible choice of benefit levels.
• Network care offers predictable costs (copayment).
• Non-network care presents a higher costs to member.
• Payments are fee-for-service.
• Employer/Employee Cost is higher than an HMO product.

To learn more about traditional (indemnity) plans, click here.