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Office of Group Insurance. What is a PPO?. PPO Basics. A Preferred Provider Organization (PPO) is a Health P lan W ith an Established P rovider N etwork that has Agreed to Accept S pecific P ayment L evels for Specific S ervices. The PPO is not a Health Maintenance Organization (HMO).

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ppo basics
PPO Basics
  • A Preferred Provider Organization (PPO) is a Health Plan With an Established Provider Network that has Agreed to Accept Specific Payment Levels for Specific Services.
  • The PPO is not a Health Maintenance Organization (HMO).
what are the benefits
What Are the Benefits?
  • Patients can “Self-Refer” Themselves to Specialists.
  • In a PPO, you are Free to Select any Health Care Provider.
  • Lower Deductibles, Higher Reimbursement, and the Lowest Possible Out-of-Pocket Expense.
fy2012 ppo plans
FY2012 PPO Plans
  • Pharmacy, Dental, and Vision Benefits are Unchanged.
  • A New Premium Category has been added.
  • The FSA Limit has Been Increased, along with the IBHP In/Out-Patient Co-Payments.
  • Enhanced Wellness Benefits and Well Baby Nursery Benefits.
fy2012 traditional plans
FY2012 Traditional Plans
  • Employee Premiums Will Increase by 15%.
  • Traditional Plan Benefits are Unchanged.
  • Co-Insurance is Unchanged at 80/20 of Allowable Charges.
how do the plans differ
How Do the Plans Differ?
  • The PPO Plan Network is Slightly Smaller than the Traditional Network.
  • Monthly Premiums are Less than the Current FY2011 Traditional Insurance Plan.
  • The Co-Payment is $20 for Physician Office Exams.
  • Co-Insurance is 85/15 of Allowable Charges In-Network and 70/30 Out-of-Network.