Preferred Provider Organization Plans — PPO Plans, Coverage, & Quotes
PPO insurance type of managed care health insurance for students. A PPO health plan (Preferred Provider Organization) consists of a group of doctors, hospitals, and other providers of medical services. PPO plans require you to pay monthly premiums and covers unlimited health care services, but offer more flexibility than HMOs. Each doctor visit, prescription refill, or medical test results in you having to shell out a co-payment under a PPO student health insurance plan; this co-pay normally ranges from $10-$30. In addition, you will have to pay a deductible before the coverage takes effect, usually to the tune of several thousand dollars annually. However, most PPO plans count co-payments towards it.
PPO health plans allow you to participate in “self-referral”. You don’t have to wait for your primary care physician (PCP) to approve any visits to specialists. If you choose a specialist within the PPO insurance plan’s network and make an appointment on your own, your affordable student health insurance will still cover it. As a result, you’ll save the money that would otherwise be spent on a co-pay to see your PCP for the referral and the time required for that visit. It is far more costly to see an out-of-network doctor, but the option is available to you. PPO plans will cover the portion of the bill in that case, although you will be responsible for filing claims in order to receive that reimbursement. Going out-of-network could be helpful for someone with a rare condition requiring special treatment from specialists unlikely to be covered in a PPO health plan.
With a PPO health insurance plan, you are allowed to visit any doctor you want, whether or not they are in your student health insurance plan’s network. Still, it’s a good idea to stay in-network, because like managed care policies, the provider network includes doctors who have agreed to charge discounted rates to plan members. This means that you will only be responsible for a small co-payment per visit. opposed to other individual health insurance plans that force you to cover the entire cost of out-of-pocket, PPO plans will pay part of the bill. If you want to see an out-of-network physician, you’ll have shoulder more of the cost yourself, but PPO student health insurance plans will pitch in. This differs from other types of college students’ health insurance, which leave you with the entire bill if you stray from their network. It’s always a good idea to compare the networks of several PPO plans to find out if the physicians and/or specialists of your choice are included. For example, a PPO plan may cover 80% of the cost to see an in-network physician, but will only reimburse 50% of the cost to see an out-of-network one. Also be warned that a lot of PPO plans only cover the specified percentage of “reasonable costs” for out-of-network medical treatment, as opposed to the actual charges. As a result, you may end up responsible for any remaining bill above and beyond the co-insurance percentage.
You don’t even have to have a primary care physician at all if you don’t want to; it’s not mandated under most PPO health insurance plans. Unfortunately, this freedom from gatekeepers comes at a price. PPO plan premiums are normally higher than those of other types of student health insurance plans, and PPOs are even more expensive after you factor in co-insurance percentages and co-payments. However, choosing a high deductible may put a cheap student health insurance PPO within your reach.
Looking for PPO student health insurance? VitalOne’s licensed insurance agents are ready to assist you in comparing PPO health plans. Contact us for a free student health insurance quote.