Preferred Provider Organization (PPO)
A group health plan is a type of insurance that can be purchased by an employer to provide benefits to its employees.
The main benefit of a group health plan is that the cost of coverage is shared by the employer and employees, allowing both parties to save money on their monthly premiums.
What is a Group PPO?
A PPO (preferred provider organization) creates a provider network consisting of providers and medical facilities for patients to receive care.
They allow you to choose your own doctors and hospitals while paying lower premiums than HMOs.
In this type of health plan, the employer purchases coverage on behalf of employees and their families. Employees pay a fixed monthly premium, and employers pay a fixed percentage of the premium (usually 80-100%).
Unlike a group HMO, referrals are not required. Since your primary care provider (PCP) isn’t required to give you a referral, you may spend more time finding and coordinating care when you need it.
What Does a Group PPO Cover?
Group PPO plans generally cover visits to a primary care physician and preventative care, such as cancer screenings, vaccinations, and annual physicals. They also cover mental health care and prescription drugs.
Hospital and outpatient care are also paid for, as well as maternity care. Diagnostic tests, imaging studies, and specialists are also covered in PPO plans.
Both in-network and out-of-network providers are covered.
However, out-of-network costs are usually higher. You can also travel and receive care outside your region because you can receive care outside of your provider network.
What Isn’t Covered by a Group PPO?
Group PPO plans do not typically cover dental benefits. They also tend to have deductibles that need to be met before coverage fully kicks in. This means that you’ll end up paying out of pocket for services until you meet them.
Group PPO Limitations
While group PPOs have plenty of benefits, they do have limitations.
They usually have higher co-pays than HMOs, but this can be balanced by having fewer restrictions on where you can receive care and the freedom to go out-of-network when necessary.
In this type of insurance plan, employers may also choose specific doctors and hospitals that are part of the network.
Additionally, they can change the network of providers at any time if they feel it’s necessary to do so.
Group PPOs have greater flexibility, but with this comes a great cost. For many, it provides the ideal coverage for their needs.