Group Insurance Benefits ExplainedGet the details, guidelines, pros and cons, and future outlook of Group Insurance Benefits from the specialists

UnitedHealthcare (UHC), a major insurance carrier, is working to help mid-size business owners manage the cost of health insurance for themselves and their employees.

They realize that medical coverage is one of the major expenses a business has and they realize that escalating costs are crippling businesses.

They have introduced a “slimmed down” PPO plan that gives businesses an affordable PPO alternative.

Watch the video for an overview.

Contact Nelson at Nico Insurance Services today for a quote for this new PPO insurance from UnitedHealthcare.

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PPO Referrals

Most people have a primary care physician that they go to who would refer them to a specialist if necessary. But sometimes, you or your employees covered by a PPO plan may have the need to go to a specialist and do not have a primary care physician or do not want to waste time and money seeing them first.

In these cases, you would want to make sure that your group health plan allows an individual to consult a health care practitioner of their choice without a lot of hassle.

To make sure your health plan handles referrals to specialists in a user friendly way, ask the following three questions before choosing a PPO plan.

1. Is an approval procedure required for getting a specialist referral or a diagnostic test or treatment in-network or out-of-network?

2. Are there any restrictions on getting second opinions from an in-network or out-of-network provider?

3. Where are decisions made about specialist referrals, testing, treatment, surgery and hospitalization?

Note that in all cases, it usually costs more to see an out-of-network provider rather than an in-network provider.

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This is the first in a series of blog posts that will the different group insurance benefits medical plans.

The first type of plan I want to talk about is the Preferred Provider Organization plan, better know as a PPO plan for short – after all, that’s quite a mouthful.

A PPO plan is a more flexible plan and has many advantages:

• It allows you to see any doctor you want.
• You do not have to designate a primary care physician.
• You can usually see any specialist without referral.

A PPO Plan does have some limitations – remember the PP in PPO is short for “preferred provider” and refers to all of the doctors and health care providers that have signed an agreement with the insurance carrier.  When a doctor or health care provider is on the preferred provider list they are considered “in network”. Those not on the list are considered “out of network”.

If the doctor you use is in network it will cost less than if you see a doctor out of network. There are basically two reasons for this. The first is that a PPO sets different deductible payments for in network versus out of network providers.

Secondly, the PPO determines a reasonable cost for each medical procedure and will only pay a percentage of what they decide is a fair cost. If the out of network provider doesn’t agree, you will be responsible for your percentage plus the difference between the bill and what the PPO says is a reasonable cost.

Up next…So Many PPO Plans to Choose From

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