Indemnity PPO (Preferred provider organization) is a type of health insurance that combines the features of traditional indemnity plans with preferred provider networks. These plans are managed care plans that cover most medical services but allow you to choose your own doctor and hospital.
The plan pays for 80% or more of covered services up to a certain amount each year, with your responsibility as the insured to pay any deductible or co-payments. In return for paying these amounts, you get access to whatever doctors and hospitals in their network accept them as payment in full or partial payment arrangements with no waiting period if there is an emergency situation requiring immediate attention by a specialist from outside their network, hence the’ ‘indemnity’ part.
Let’s look at the benefits of an indemnity PPO plan
An indemnity PPO plan combines the features of traditional indemnity plans with preferred provider networks
With an indemnity PPO plan, you’re covered by a network of doctors and providers. The big difference between this type of plan and traditional indemnity plans is that the network typically has more limited coverage than traditional indemnity plans.
In some cases, you can pay out of pocket for services outside the network if you want to see a specific doctor or provider. However, doing so may affect your out-of-pocket costs if your plan doesn’t cover those services.
With indemnity plans, you can see any doctor you wish
You are not limited to a network of providers. You can see any doctor or go to any hospital you want. You’re responsible for the full cost of your care, up to the plan’s maximum benefits.
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Benefits are based on a percentage of what the carrier considers reasonable charges. You can visit any provider or doctor and still receive benefits at a set rate.
- You can go to any hospital or doctor, but certain providers may cost less
- If you go to a preferred provider, you get more benefits
- If you go to an out-of-network provider, you may still be covered, but you will have to pay more.
What are the Features of Indemnity PPO?
Improved flexibility
Indemnity PPO plans are not like the usual HMO plan. Instead, they are a combination of an HMO and PPO plan. It is also called an EPO (exclusive provider organization) and POS (point of service) plan. The main concept behind indemnity PPO is that it gives its subscribers flexibility to choose the hospitals and doctors. However, one must pay for medical services up-front before seeking reimbursement from the insurance company. This does not mean that you have to pay for the complete expense out of your pocket. Rather, you will be able to claim a percentage as reimbursement from the insurance company.
Lower costs
Indemnity PPO usually has lower costs than other health insurance plans. It is normally inexpensive because there are no deductibles. You can receive treatment from any doctor or hospital you want without worrying about any restrictions.
Wide range of coverage
Indemnity PPO offers a wide range of coverage for inpatient, outpatient, preventive and diagnostic procedures and treatments, such as checkups and immunizations, prescription drugs, and more.
Affordable
An Indemnity PPO plan is an affordable option. This plan includes a predetermined amount of coverage, and if you visit a provider who doesn’t participate in your plan, you’re responsible for paying 20% of the cost out-of-pocket. The difference between indemnity and HMO plans is that if you have a procedure done outside of the network, you might have to pay more than 20%.
Reliable
Indemnity health insurance plans are traditional indemnity plans. These plans reimburse clients for all uncovered medical expenses that the insurance company approves. Indemnity health care plans are designed to reimburse clients for out-of-pocket costs that exceed a set limit.
These plans also provide coverage for office visits and emergency room services. Some indemnity plans may limit the amount of reimbursement for emergency room visits, and some may not cover office visits at all.
Indemnity PPO plans are available in many states, though they do not offer the same level of coverage as HMO or POS plans. Basically, indemnity PPOs are an alternative to HMO and POS plans, with lower premiums and deductibles but higher out-of-pocket costs if you choose to go to out-of-network providers
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Bottom Line
An indemnity PPO plan is a popular form of health insurance that allows the insured to select their own doctor. The insured pays a deductible, coinsurance, and co-payment for services rendered by in-network providers. The out-of-pocket costs can be much lower than other types of plans.
