Employee Benefits

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Employee Benefit and Planning
Chapter 12

What is the term PPO stands for? Preferred Provider Organization What is the Characteristics of PPO? Tends to be used in two ways. One way to apply to health care providers that contract with employers, insurance companies, union trust fund, third-party administrators, or others to provide medical care services at a reduced fee. PPO may be organized by the Providers themselves or by other organizations, such as insurance companies the Blues. Like HMO they may take the form of group practices or separate individual practices, they provide a broad array of medical services such as Physician¡¦s services, hospital care, laboratory costs¡K or they may be limited to hospitalization or physician¡¦s services. The benefit plans that contract with PPO to obtain lower cost care for plan members. How PPO+HMO differ? First the preferred providers are paid on a fee for a service basis as their services are used. Second employees and their dependants are not required to use the practitioners or facilities that contract with PPO; rather choice can be made each time medical care is needed, and benefits are also paid by nonnetwork providers, but employees are offered incentives to use network providers; they include lower or reduced deductibles and co-payments as well as increased benefits. Most PPO¡¦s do not use primary care physician as a gatekeeper; employees do not need referrals to see specialists third PPO do not monitor their preferred Providers as closely as HMO¡¦s. However those that operate as traditional HMO generally provide medical expense coverage at slightly lower cost than traditional PPO¡¦s. Chapter 13

Know what HSA are? Improvement and modernization act established (HSA)= are savings account for use with high deductible medical expense plans and from which certain unreimbursed medical expense can be paid it is a personnel savings account fully owned by the account holder. Participation can be limited to individual...
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