PPO Issues/FAQ

Group Health Insurance Quotes

• Get a plan with a higher co-payment
• Consider a PPO over an HMO
• Look at plans with high deductibles and out of pocket expenses
• Try to get into a group plan

Health Insurance Buying Tips

• Shop carefully. Policies differ widely in coverage and cost
• Make sure the policy protects you from large medical costs
• Find out the waiting period & what's excluded
• Find out what the "free look" clause is
• Beware of single disease insurance policies

Choosing a health insurance is dependent on two things:

1. your needs; and
2. your budget.

There are two main types of health insurance plans:

1. HMOs; and
2. PPOs.

Let's look at both of them separately:

With an HMO (Health Maintenance Organization), you pay a monthly premium and the HMO covers your medical care. You must use the doctors and hospitals designated by the HMO.

An Health Maintenance Organizations (HMO) is for people who:

• Want to holding down premiums by limiting medical choices
• Don't travel
• Don't want to fill out forms or keep receipts
• Want insurance that fully pays for routine and preventive care
• Don't mind waiting for an appointment
• Depend on their doctor entirely to recommend a specialist
• Are willing to give up some choices to hold down their medical costs

In almost all HMOs, you are choose one primary care doctor. This doctor provides most of your medical care, referring you to specialists and other health care professionals if needed.Before choosing an HMO, talk to people you know who are enrolled about the services and care.

As with an HMO, a PPO requires that you choose a primary care doctor to monitor your health care. Most PPOs cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammograms.

In a PPO, you can use doctors who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms).

A Preferred Provider Organization (PPO) is for people who:

• Want to go to a specialist regardless of their doctors opinion
• Want freedom to choose doctors and hospitals even if it costs more
• Travel a lot or have children that live in other states
• Don't mind filling out forms or keeping receipts
• Don't mind paying a percentage of office visits, checkups, shots, etc.
• Don't want to wait for an appointment

Questions to ask about a health insurance plan:

• Are there many doctors to choose from?
• Which doctors are accepting new patients?
• How hard is it to change doctors?
• How are referrals to specialists handled?
• Is it easy to get an appointment?
• How far in advance must routine visits be scheduled?
• How does the plan handle emergency care?
• What preventive services are provided?
• How convenient to your home and work are the facilities?
• How do you get medical treatment out of town?
• What are the annual premiums?
• What are the copayments for office visits, prescriptions, etc?
• What services are covered?
• Do they pay anything if you use a doctor outside the plan?
• Is there a deductible and coinsurance rate?
• Is there an annual maximum you pay out of pocket?