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California
Group Health PlanIn The Form Of A PPO
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A California group health plan that is classified as a preferred provider organization (or abbreviated to PPO) means that it combines the aspects of a traditional fee-for-service plan with a health maintenance organization (HMO). Some people can easily appreciate a California group health plan that incorporates both of these types of healthcare plans into one.
Just as in the case with a health maintenance organization, those who choose a PPO must accept that there is only a limited selection of physicians and hospitals from which they can choose to deal with. These specific doctors, hospitals and clinics are providers of services to insured members and are sometimes referred to as “preferred” providers or “network” providers. In a PPO health care system, the majority of a member’s medical bills are covered by their plan.
When it is necessary to visit a doctor in the California group health plan that is a PPO, you must show your health insurance card but the PPO will fill out all of the necessary forms for you. In some cases there is a co-payment for visits, which is generally no more than five dollars per visit. A co-payment or “co pay” is defined as, “a flat dollar amount paid for a medical service by an insured person.” For a certain number of health services there will also be a deductible as well as coinsurance to pay.
This type of California group health plan resembles an HMO in that the insured member must choose a primary care physician to go to at all times for health problems. In most incidences PPOs do cover preventative healthcare costs such as doctors’ visits, immunizations, well-baby care and visits and mammograms.
A PPO California group health plan is more like fee-for-service however in that patients are able to go outside of the PPO for care they need that they are unable to receive within the PPO and still be covered to a certain extent by their plan. In this case the member will pay a larger percentage of the bill for medical service but they are guaranteed the medical service they require. If you need to go outside of the PPO for medical service you will be required to fill out all of your own claim forms. If you already have a doctor you like who is not a part of the PPO form of the California group health plan you can keep your doctor while still choosing this form of group heath coverage. In this case everyone wins.
Learn more at: www.baahealth.com
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