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PPO

Preferred Provider Organization is a managed care option that provides a network of providers. These are generally provided to a patient in the form of a list of providers that they may use. Under a PPO a patient has the freedom to use providers that are not on the list but would have to pay higher co-pay, often as high as 50%. A PPO also offers an alternative to keeping premiums low by having the patient pay coinsurance and deductibles. One benefit to a PPO over an HMO is that you are not required to have a primary provider; therefore you generally don’t require a referral to see a specialist.

Advantages of a PPO

Ø May include a larger network of providers, often nationwide.

Ø Freedom to choose among listed doctors.

Ø No referrals needed or pre authorization for specialists.

Ø Lower co-pay for using generic prescriptions.

Ø Does not require the patient to file claim forms.

Ø Deductible may be waived for maintenance visits.

Disadvantages of a PPO

Ø Higher co-pay for out of network providers.

Ø Can be more expensive than an HMO.

Ø Has annual deductible that has to be met before coverage for visits other than maintenance, such as emergency care.

Ø Co-pays can be larger than those in HMO

For more information and comparisons to HMO click here

If you wish to shop for different PPO’s you can click here

Blue Cross of California offers many different PPO’s for the individual, group or state sponsored programs click here Go to the Visitors link.

HealthNet also offers PPO’s and other plans click here for more information. Then follow the links to California and then Individuals and Family Plans.

Mandatory Insurance Law- SB2

Democratic Senate President John Burton authored SB2 the Mandatory Insurance Law that was signed by Governor Gray Davis on October 5, 2003. SB2 requires companies with 200 or more employees to buy medical coverage for workers and families by January 1, 2006. Companies with 50 to 199 employees would have to comply by 2007. Companies with 21 to 49 employees would be exempt until further action can be taken to subsidize the cost. SB2 will require that businesses provide medical coverage for employees that work at least 100 hours per month at businesses falling under the above guidelines. They have the option to provide medical coverage directly and receive a credit towards the program. If they don’t provide medical coverage directly they will be required to pay into a state run program. The law also protects the employees from taking the full responsibility that employers might pass on to them. SB2 says that employers must pay at least 80% of the health premiums and employees will only be responsible for 20%. If an employee is considered low- income they will only be required to pay 5% of their income towards the health insurance (http://democrats.sen.ca.gov, 3/2/04). The law does not provide a required level of coverage.

Below are links to more information on SB2

To read the bill click here and then click the link Bill Information and follow the prompts.

The Democrats published an Op Ed read it here

The opposition published an informative article read it here

More information about the Referendum to stop SB2 click here