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Health Insurance Glossary


A preferred provider organization (PPO) is a healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers who contract with the PPO at a discount. Preferred Provider Organization (PPO) plans are the number one choice for millions of Americans.

PPO plan gives you freedom of choice, flexibility and a broad range of benefit options. With the PPO product:

  • There is no need to select a primary care physician; you can choose a doctor whenever you need care.

  • You do not need a referral to see a specialist or to get another opinion about a medical condition.

  • The choice of doctors and hospitals is always yours.

PPO Advantages

With the PPO plan, you have access to a large network of contracting doctors and hospitals

With the PPO plan, benefits may include coverage for:

  • Doctor office visits

  • Inpatient hospital services

  • Outpatient hospital services

  • Maternity care

  • Hospital emergency medical and accident treatment

Preventive Care

Coverage may also include preventive care benefits for well-child and adult care, including:

  • Physical exams

  • Diagnostic tests

  • Immunizations

Use Network Doctors and Hospitals for Greater Benefits

Benefits are paid at the highest level when you receive care from network PPO doctors and hospitals. When you receive care from network PPO doctors and hospitals:

  • There are no claim forms to complete.

  • There are no up-front payments for medical services (except for copayments) and charges for non-covered services.

  • There’s no balance billing—network doctors and hospitals accept insurance companies’ negotiated rates.

You always have the option to receive care outside the network, but your benefits will be paid at a lower level.

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