A PPO is a Preferred Provider Organization which pays a higher benefit percentage for services from an in-network provider, and a somewhat lesser benefit percentage for services from an out-of-network provider.
The 80/60 PPO plan has a $350 individual calendar year deductible and a $700 family deductible.The Medical Mutual SuperMed PPO utilizes the SuperMed Plus provider network. The Anthem Blue Cross/Blue Shield PPO utilizes the Blue Access (PPO) network.
In these plans, you do not need a referral for specialist services. In-network inpatient, outpatient, and diagnostic services are covered at 80% after the deductible is satisfied. Out-of-network coverage for these services is covered at 60% after the deductible has been satisfied. Some services have a co-pay amount which is not subject to the deductible. For example, an office visit to an in-network Primary Care Physician simply requires a $15 co-pay. Several routine services such as annual well-woman exams and well-child immunizations also require only the $15 co-pay if an in-network provider is used. In-network coverage for routine mammograms and routine PSA testing is at 100%.