What is a PPO?
A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.


If you obtain care from a medical provider outside of the PPO network, you will pay more for the service. For example, a PPO may pay 90 percent of the cost for a visit with an in-network doctor, but only 70 percent of the cost for a visit to a non-network doctor.


You will typically pay a copayment for each visit/service. These copayments are typically higher than an HMO copayment, but not always. You will usually be responsible for paying an annual deductible.


If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs are likely to be somewhat higher.


What is a HMO?
An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.


If you obtain care without your primary care physician's referral or obtain care from a non-network member, you may be responsible for paying the entire bill (with exceptions for emergency care).


With some HMOs, you pay nothing when you visit in-network doctors. With other HMOs there may be a copayment for the visit or service.


With most HMOs you will not be responsible for paying a deductible.


If you join an HMO, you should find that you have few out-of-pocket expenses for medical care if you use the doctors or hospitals that are part of the HMO.


What is a provider?
A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.


What is a deductible?
A deductible is the amount of annual medical expenses that a health plan member must pay before the plan will begin to cover expenses. For example, if your plan has a $250 deductible, you will pay the first $250 of you medical expenses before your health plan begins paying the expenses. Only expenses for covered services apply towards the deductible.
What is the difference between an in-network and an out-of-network medical provider?
An in-network medical provider is within the list of providers chosen by a particular health carrier. Out-of-network providers are providers who are not included on this list. If you visit a physician within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network physician.


What is an Archer Medical Savings Account?

The Archer MSA program enables certain persons (self-employed individuals and employees of small employers) with high-deductible health plans to contribute on a tax-free basis to medical expense reimbursement accounts. For details on this type of account, try this IRS link: http://www.irs.gov/pub/irs-pdf/p969.pdf

Where can I go if I have COBRA questions?
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html


Where can I go if I have HIPAA questions?
Click here for HIPAA FAQs

IRS HSA Guidance
HSA Frequently Asked Questions