Types of Group Health Insurance: All About PPOs

Posted on: December 9, 2019 by iSure

Last month, we explored the main types of group health insurance and the coverage they offer. This month, we’re going to take a deeper dive into each of the three primary plans that we offer: PPOs, HMOs, and CDHPs. We’ll be starting with the classic PPO.

A preferred provider organization (PPO) is a medical care plan in which medical professionals and facilities provide services to subscribed clients at reduced rates. You can reach out to your group health broker to discuss how this plan would benefit your employees.  

PPO, Explained 

This managed-care organization consists of medical professionals and facilities such as primary and specialty physicians, hospitals, and other healthcare professionals. These professionals partner with insurance providers to offer subscribed participants services at an agreed-upon reduced rate. In exchange for reduced rates, insurers pay the PPO a fee to access the network of providers.

Providers and insurers negotiate fees and schedules for services. PPO participants are able to use the services of any provider within their network, while out-of-network care is available for an added cost. If out-of-network claims exceed the reasonable and customary fees for services rendered, coverage may not apply or, typically the excess charge will be the responsibility of the patient. Subscribers generally pay a co-payment per visit, or they must meet a deductible before insurance covers or pays the claim.

The Benefits 

Unlike other plans, a PPO is unique in that it offers freedom to receive care from any provider in or out of your network, meaning participants can see any doctor or specialist, or use any hospital.

In addition, the plan doesn’t require you to choose a primary care physician (PCP) and do not require referrals. If your employees already have a doctor they like, you can continue receiving care from that provider.

Another significant perk to this plan is if one finds themselves in need of medical care when they are far from home, they are able to see any healthcare provider. 

Is it Right for Your Employees? 

PPO plans tend to charge higher premiums due to higher administration and management needs. However, they offer more flexibility compared to alternative plans. PPO networks are large, with wide provider options in many cities and states. This flexibility of accessing a provider in urgent situations is very valuable to participants.

A PPO is generally a good option for employees who want control over their choices and don’t mind paying more for that ability. It would be especially beneficial for those who travel often, since a primary care physician is not needed. For more help deciding if a PPO plan is right for your business, contact your group health broker. 

For more information or inquiries, be sure to take a look at our Group Health Insurance page. Come back next week to learn more about HMOs!

About iSure Insurance Brokers

After serving leaders in the Greater Miami market for more than three decades, iSure Insurance Brokers has become the provider of choice for discerning commercial clients and individuals alike. Because no two insurance programs are or should be alike, you can be sure that iSure will craft a comprehensive approach to protection that is as unique as you are. We welcome the opportunity to protect what you have worked so hard to build. Please contact us at (305) 223-2533 to learn more about what we can offer you.

Posted in: Blog Group Health Healthcare Insurance