Preferred Provider Organization (PPO)

Plans consist of doctors, hospitals, labs, pharmacies and other health care providers that have signed contracts with the carrier to provide services at agreed upon prices that are called “Contract Rates”, which are less than their normal rates. These providers are called “In Network PPO” service providers

There is no Primary Care Physician (PCP) so members may choose to obtain medical care from any service provider in, or out of the network depending on the plan

The “Annual Out of Pocket Maximum” is your annual “Stop Loss” & accrues the total of your copayments for services rendered throughout the year. Usually benefits are 100% covered once this amount is paid. This typically does NOT include your deductible and is reset to $0.00 on January 1st of each year. Sometimes it includes copayments and deductibles and sometimes not.