Employee Benefits and PlanningWhat does the term PPO mean? Preferred Vendor OrganizationWhat are the characteristics of PPO? It tends to be used in two ways. A way to address healthcare providers who contract with employers, insurance companies, union trust funds, third-party administrators or others to provide medical care services at a reduced rate. The PPO can be organized by the Providers themselves or by other organisations, such as Blues insurance companies. Like HMOs, they may take the form of group practices or separate individual practices, provide a broad range of medical services such as physician services, hospital care, laboratory costs, or may be limited to hospitalization or doctor visits. services. Benefit plans that contract with PPOs to obtain lower-cost care for plan members. How are PPO+HMO different? First, preferred providers are paid on a per-service basis based on the use of their services. Second employees and their dependents are not required to use professionals or facilities affiliated with PPO; rather, a choice can be made whenever medical care is needed, and benefits are also paid by out-of-network providers, but employees are offered incentives to use in-network providers; include lower or reduced deductibles and co-payments as well as increased benefits. Most PPOs do not use the primary care physician as a gatekeeper; employees do not need referrals to consult specialists. Third-party PPOs do not monitor their preferred providers as closely as HMOs. However, those that operate as traditional HMOs generally provide medical expense coverage at a slightly lower cost than traditional PPOs. Chapter 13. Do you know what HSAs are? Established Improvement and Modernization Act (HSA) = are savings down payments...... middle of paper...... take responsibility for their child's health care expenses, and that parent's plan has actual knowledge of the terms of the court order, then that plan is primary" applies, the plan that covers the person for the longest period is primary" who is the spouse of the custodial parent is secondary. c- the non-custodial parent's plan is tertiary d- the stepparent's plan which is the non-custodial parent pays last.Know Ok it has a 30 day coverage extension + up to 6 months extended benefitsKnow what COBRA