What is a PPO plan?
he following Questions & Answers are presented only as general information about the plans offered by Piedmont Community Health Plan and Piedmont Community HealthCare. The documents provided to you by your employer, such as Summary Plan Description, Evidence of Coverage, Certificate of Coverage and Schedule of Benefits, will prevail for all benefits, conditions, limitations and exclusions. If your plan requires that you select a primary care physician to coordinate your medical care, then you are covered by a Point of Service plan. Members who are covered by a Preferred Provider Organization plan are not required to select a primary care physician. However, both plans require that members use a physician or other provider who is a member of the Piedmont Community Health Plan network. Additional information is also available from your employer’s human resource department and from Customer Service, Piedmont Community Health Plan at 434-947-4463 or toll-free at 1-800-400-7247.
A PPO plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service to their policyholders. Generally, the preferred service provider agreed to accept an insurance company’s usual and customary payment. If you have a PPO contract and do not use the preferred service providers, you may find yourself paying more for services rendered by the physician or hospital.
A PPO, or Preferred Provider Organization, contracts with physicians and hospitals to secure preferred rates for you and your covered family members. You can decide to visit a PPO provider any time medical care is needed. Should you choose a non-PPO provider, a lower level of benefit may apply. When you choose a PPO provider, you will receive quality medical care and the highest level of benefits. ODS contracts with several PPO networks to provide more physician choices and geographic coverage.
A. A PPO (Preferred Provider Organization) plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service for their policyholders. Generally, the preferred service provider agreed to accept an insurance company’s usual and customary payment. If you have a PPO contract, and do not use the preferred service providers, you may find yourself paying more for services rendered by the physician or hospital.
