A health insurance PPO plan is a type of managed medical plan that provides health care for its members at lesser costs. PPO stands for Preferred Provider Organization. This type of plan has several advantages that you might find very useful. Several doctors and hospitals have contracts with PPOs so that medical services are provided to the insured at a reduced fee. Health insurance PPO plans cost more than HMO plans, but that's because PPO plans give you more control over your health plan. Emergency room visits are usually covered in this type of plan. You can also choose any doctor for consultations or any hospital if you need treatment so long as they are part of the PPO's network. Seeing an out-of-network specialist is allowed in this type of plan, although you should epect to pay more since that specialist is not part of the plan. Usually, you'll receive 90% reimbursement for services received from in-network doctors, but you'll only get up to 60% reimbursement for receiving out-of-network medical services. With a health insurance PPO plan, PPO members have to pay for services as they are rendered. The PPO sponsor (insurance company) will just reimburse the member for the cost of the service less the co-payment percentage. The doctor's office might send the bill directly to the insurance company before the member is required to pay the co-payment amount. - June 26, 2009 @ 1:46 pm