Speak to an advisor

888-258-6270

Don’t Miss the 2018 Health Insurance Open Enrollment Period from Nov. 1 to Dec. 15

What Is a PPO?

What Is a PPO?

Posted Feb 23, 2016 by Jenifer Dorsey

 

If you’re in between Obamacare plans and have been shopping for temporary benefits, you may have encountered short term health insurance products with PPO in the name or description. What does this mean, and how are these plans different than an Obamacare plan PPO or even other short term plans?

Let’s break it down.

1.  What is a PPO?

PPO stands for preferred provider organization, and a preferred provider organization is a type of health insurance plan network in which doctors, hospitals and other healthcare providers contract with a health insurance company or third-party administrator to provide healthcare at a reduced rate to their clients.

Unlike HMOs (i.e., health maintenance organizations), which typically require you to seek care from contracted providers, PPOs typically allow you to chose in- or out-of-network providers. Whereas an HMO is unlikely to cover any out-of-network care that is not an emergency, a PPO plan often covers a certain percentage of out-of-network care regardless of whether or not it is an emergency.

However, if you are insured by a PPO plan and receive care from out-of-network providers, you will typically pay more out of pocket. Conversely, you will generally pay less when you receive care from providers that participate in your PPO plan’s network.

2. What is short term health insurance?

Short term health insurance is what consumers often call short term medical, or STM, plans. A short term health plan provides temporary benefits for 30 days to 6 months—sometimes up to 364 days, depending on your state. You pick the policy length you need when you apply and enroll.

Short term plans are not ACA compliant. That means they are not a replacement for Obamacare coverage and will not prevent you from owing a tax penalty, and you may not qualify for one if you have a preexisting health condition.

However, when you are in between Obamacare plans, short term coverage can offer a range of benefits to help pay for unexpected medical care.

3. STM + PPO – What happens when you put them together?

You get a short term PPO plan. So, what does that actually mean?

A benefit of many short term health insurance plans is that they are designed without networks, which means you can receive care from the doctors and hospitals you prefer. Sometimes these plans partner with national provider networks, and these partnerships provide you with access to discounts from select doctors and hospitals.

However, sometimes consumers want access to networks and the money-saving features PPO coverage can offer. A short term PPO, while not the same as the ACA-compliant plans you purchase from the state and federal exchanges or in the private market, is designed with some similarities to major medical PPOs. These features can help you lower your out-of-pocket healthcare costs and include:

  • Rx copays
  • Office visit copays
  • Discounts on healthcare received from network providers

Short term PPO plans sold through healthedeals.com come in several plan designs, and you can pick your in-network deductible as well as your coinsurance percentage and out-of-pocket amounts. Some short term plans, including Connect Net from The IHC Group, which is available in certain states through healthedeals.com, even include a few preventive care benefits.

How can I get a short term PPO or traditional short term plan?

Call the number at the top of your screen to speak with a health insurance producer (i.e., a certified advisor, agent or broker) who can answer your questions and assist you in finding a short term health plan that meets your personal needs.

Want to start looking on your own? Click on the blue button below to get a quote—there’s no personal information required until you apply. If you need help at any point along the way, just call us. Otherwise, you can apply and enroll online within minutes and begin your coverage as early as the next day.

 

Find an STM PPO

 

References:

HealthCare.gov. “Preferred Provider Organization.” https://www.healthcare.gov/glossary/preferred-provider-organization-PPO/

U.S. Department of Health and Human Services. “What You Should Know About Provider Networks.” Revised September 2015. https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf

Wikipedia. “Preferred Provider Organization. https://en.wikipedia.org/wiki/Preferred_provider_organization

 


 

SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.

About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.

About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.