The percentage of people with employment-based health insurance dropped from 70 percent in 1987 to 61 percent in 2004. This is the lowest level of employment-based insurance coverage in more than a decade.
The
Preferred Provider Organization Plan (PPO)
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The Preferred Provider
Organization plan has common ties to both a HMO and
a traditional pay-for-service plan. The PPO is a system
of physicians, hospitals, and medical facilities that
share a belief in providing healthcare at a moderate
fee. Individuals have the freedom to choose to visit
any licensed healthcare provider. And unlike other plans,
choosing a primary care physician is unnecessary, as
is a referral to see a specialist. This plan offers
more freedom for individuals to choose.
Individuals who choose to
visit a PPO-affiliated doctor will pay a co-pay or predetermined
set amount for services, such as regular office visits
and prescriptions. The individuals or medical providers
are responsible for submitting claims and the policy
holder will be reimbursed for the cost of the visit,
if paid in full, minus the amount of the co-pay. If
a PPO networked physician handled the individual’s
care, the insurer will pay approximately 90% of the
costs under most PPO plans. If the individual chose
to visit a physician or specialist outside the PPO network,
the insurer might only reimburse 70% of the cost. Even
though the paid amount is less than for the PPO networked
physician, this is a benefit of the PPO plan—you
get some coverage no matter where you choose to go.
Individuals looking for
a plan that allows great flexibility in choosing what
physician or confident that they know when a specialist
is necessary; this would be an excellent plan to choose.
One example might include the choice to schedule a visit
to a dermatologist for a teenager with acne problems.
With other plans, the individual would have to get a
referral from their primary care physician to even visit
the dermatologist, but with a PPO that would not be
necessary. This plan gives you that self-referral advantage.
The PPO plan is more “middle
of the road” in health insurance plans. Basically
there are financial advantages to visiting a PPO physician
and still coverage if you choose a physician outside
the PPO network. Co-payments are standard. And with
a PPO, ultimately you decide who best serves you and
your family.
Family-Health-Insurance reviews insurance services to provide information on products and options, but is not an insurer or a licensed agency. Coverage and policies described on this site may not be available in all states.
