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What is a PPO and why is it important to you?

A PPO, also known as a Preferred Provider Organization, is defined as an organization of doctors, hospital and medical care facilities that have contracted with the insurance company to all provide services at a contracted rate. Usually the rate they receive is at a reduced rate. A PPO type arrangement can be beneficial for both the insurance company and the insured. The rates are usually significantly reduced so the insured does not have to pay as much out-of-pocket as they would if they went outside of the PPO. The insurance company also receives the lower rate so in effect they do not have to pay high claims amounts. This in turn, allows your renewal and premium rates to remain as low as possible.

With most of our plans, they do offer a PPO. However, you are not required to follow it. If you do choose to go within the network or PPO, then you will receive significant benefits. For example, the Student Secure plan, offers the coinsurance (coinsurance is the percentage that you would responsible to pay after the deductible) to be waived (select level only) if you go within the PPO or to the Student Health Center. The PPO for this plan is quite vast. To search the PPO go here: www.InternationalStudentInsurance.com/network. This can greatly reduce your out-of-pocket expenses. If you went to the emergency room let’s say for a broken arm and your total eligible expenses were $2,000 (the hospital you went to was in the PPO and all of your expenses were eligible expenses). The insurance company would pay 100% of your eligible expenses (select level only) after you paid the $100 deductible (the deductible is the amount that you are required to pay before the insurance company will pay towards your expenses).

Now let’s say for the same example you chose not to go to a hospital within the PPO. You would see much higher out-of-pocket expenses. Your deductible would remain the same however, the coinsurance would not be waived and you would be responsible for 20% of your eligible expenses (for this example it would cost approximately $500 total for you). On the select level of the Student Secure plan, the insurance company would pay 80% of your eligible expenses after the deductible up to $5,000 then they would pay 100% up to the overall policy maximum. So, as you can see, it’s much better for you to go within the PPO.

The Student Secure plan is available for full-time students studying outside of their home country. Outside of the U.S. there is not a PPO. You can go to any doctor or hospital and you will be provided 100% coverage for your eligible expenses after the deductible and up to the overall policy maximum (select level only). To find further information about all of our plans please visit our site: InternationalStudentInsurance.com


2 thoughts on “What is a PPO and why is it important to you?”

Anonymous says:

You have just saved me a lot of trouble – thank you for the explanation!

However I have also seen the word HMO when looking for insurance, could you tell me what that is?

Tariq

International-Student-Insurance says:

Hi Tariq,

Thank you for your comment.

An HMO is also known as a Health Maintenance Organization. It is similar to a PPO actually. It is a type of managed care organization that contracts with certain doctors, hospitals and other providers. In addition to medical services, HMO’s will provide coverage for preventive care (i.e. immunizations, check-ups, mammograms, etc.) typically at a reduced rate or for free. In an HMO plan, you are typically required to choose a primary care physician. These types of physicians are usually family doctors, pediatricians, general doctors, etc. If you need to see a specialist then you are required to get a referral through your primary doctor.

I hope this helps clarify it.

Best Regards,
Pam


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