How does a PPO (Preferred Provider Organization) plan work?
The PPO plan design utilizes the Piedmont network. This type of plan offers two levels of benefits, in-plan and out-of-plan. When a member utilizes network providers for covered services, they receive in-plan benefits. This is a higher level of benefits as compared to the out-of-plan benefits. Pre-certification is required for all hospital related services, including inpatient or outpatient care and diagnostic testing. When a member receives covered services from providers that are not in the network or without pre-certification, they receive out-of-plan benefits. This is a lower level of benefits, which costs the member more out-of-pocket than the in-plan level of benefits.
Related Questions
- All I have on my enrollment for medical choices are the EBPA Plan, Preferred Provider Organization (PPO) and a waive option. Why?
- Can you explain the Harvard Pilgrim’s Preferred Provider Organization (PPO) plan that’s displayed on my worksheet?
- What is a Preferred Provider Organization (PPO) plan and how does it work?
