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Preferred Provider Organization (PPO)

With our PPO, members have the flexibility to seek care from providers within or outside of the preferred network without referrals. The PPO offers a wide range of benefit designs that include incentives, such as coverage of preventive services, to seek care from preferred providers. Using out-of-network providers may cause increased coinsurance and deductibles.

Employees have greater freedom of choice in the PPO-style arrangement than in an EPA or POS plan. Groups realize savings over other traditional indemnity plans because the discounted fee arrangements with providers can result in lower premium rates. However, cost savings are not as great as they would be in a POS or EPA plan because access to the health care system is self-determined. Also, there is no PCP to help employees receive the most appropriate health care services.

ADVANTAGES OF OUR PPO:

  • Financing. This product can be offered on an experience-rated or self-funded basis.
  • Utilization reviews. Health care services – including pre-authorization, case management concurrent review process – are reviewed by our medical management team.
  • Out-of-network coverage. Employees can seek services outside the preferred network and still receive benefits that will be reimbursed at a lower level than in-network benefits. A discounted-fee schedule still applies to non-PPO providers.
  • Cost control. The benefit design can encourage participants to utilize the physician network and provider discounts, holding your costs in line.
  • Flexible cost sharing. You can choose from a wide range of benefit designs to meet the desired level of cost sharing.
  • Cost reporting. Groups with 100 or more employees receive management information reports on total health care costs.
  • Freedom of choice. In the HAP PPO product line, you can use your existing third-party administrator (TPA) or select one based on your claims processing needs. Our provider network and medical management programs can then be used to help manage cost and utilization.
  • Affinity discounts. Members receive preferred rates on services that are not covered benefits, including Weight Watchers®, LASIK (Laser in-situ Keratomileusis) procedures and Globalfit Fitness Solutions.

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