PPO and POS plans are kinds of Arizona health insurance plans. Like an HMO, these plans have provider networks, but you can choose to see doctors outside of the network and pay more.
The Arizona Department of Insurance oversees Blue Cross Blue Shield of Arizona and Blue Shield of Arizona PPO health plans.
A PPO is a preferred provider organization. A PPO is good plan for
people who want to see providers without prior approval from their plan
or medical group and who do not want to choose a primary care doctor.
You get your health care from a network of doctors and other providers, but you can choose to go outside of the network and pay a higher cost.
You usually pay a yearly deductible before the PPO starts to pay some or all of your bills.
You usually pay a co-insurance, or percent of the bill, when you get a covered service. The PPO pays the rest.
A POS is a point of service plan. It is a mix between an HMO and a
You have a primary care doctor and you get most of your health care from an HMO network.
You can choose to see doctors and other providers outside of the HMO network, but you will have to pay a much higher cost than if you stayed in the HMO network.
It is important to read your Evidence of Coverage (the booklet that
explains your benefits) to understand the costs you will have when you
go outside of the network in a Arizona PPO plan. If you see a doctor or
other provider who is not in your health plan's network, you and your
plan share the cost of the service. However, your cost will usually
depend on the plan's Maximum Allowable Amount for the service. This is
the most your plan will pay for a service. It is usually about the same
as what the plan pays providers in the network.
Before you see an out-of-network doctor, you can ask your plan to tell you how much it will pay and how much you will have to pay.
(PPO pays 90%)
(PPO pays 70%)
|The PPO's Maximum Allowable Amount for the service||$14,000||$14,000|
|Your PPO pays||$14,000 x 90% = $12,600||$14,000 x 70% = $9,800|
|You pay||$14,000 x 10% = $1,400||$14,000 x 30% = $4,200
plus all of the amount over the allowed cost:
$4,200 + $8,000 = $12,200
Related Page: Updated
Guide to 2016 Arizona Health Exchange Options
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