How the PPO Plan Works

If you go out-of-network …

… you still have benefits, but you pay more out of your own pocket for care.

The plan offers a choice. Each time you need care, you decide which provider to see. You can receive care from one of the PPO’s preferred providers or from any other provider. Your benefits are higher when you choose a preferred provider from the PPO network. 

With a PPO, there is no requirement to see a “primary care physician” or obtain a referral before seeing a specialist. You simply select a network provider and receive the care you need.

Certain services must be pre-certified for you to receive full benefits, whether your care is “in-network” or “out-of-network.” See “Pre-Certification” within this section for more information. Ask your health care provider whether he or she participates in the network(s) for your plan.

The PPO network may change from time to time. Be sure to contact your provider before treatment to determine whether he or she is still part of the network. A change in the membership of the provider network is not considered a qualified change in status for mid-year changes in coverage.