What is a PPO (Preferred Provider Organization)?

A health insurance program which allows participants to maximize their health care benefits by using providers that have a special contractual relationships with the Insurance Carrier. These providers are usually called "preferred providers" or participating providers. The Network Providers will include hospitals, physicians and specialists and ancillary providers. You are not required to have your care coordinated through a primary care physician and you are not required to obtain referrals to see a specialist. When you receive care through a Network Provider you are assured of little, if any, out-of-pocket expenses. You will also be entitled to benefits if you choose to use a provider who is not in the network. However, the level of benefits will be reduced, you will be responsible for a deductible and co-insurance amount, you will be required to file a claim form and to have the service precertified or obtain prior authorization should the service require it.

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