What Is Annual PPO Insurance Deductible
The manifest increase in health insurance cost has forced many employers to shift expenses to workers. Research has shown that the average annual deductible on conventional insurance has increase to over $1000. In the wake of this many people are enrolling under PPO or Preferred Provider Organization networks and many are not aware of the main parts of their policy agreement.
Do you have a PPO as your Insurance? Whether you have Blue Cross or Aetna policy or another other Insurance Company offering a PPO Plan policy, your PPO Plan has an annual deductible. Understanding how your PPO Plan works is important to controlling you PPO insurance cost.
Annual PPO Deductible Explained
You PPO annual deductible is the amount you pay for your medical treatment before the insurance company begins paying your insurance cost. Your annual deductible is different from the amount you pay as co-pay.
For instance, Blue Cross 1500 Individual plan has a co-pay of $40 per office visit and $10 on generic drugs. Co-pays can also include certain types of preventative care. The annual PPO deductible, however, is $1,500.
Meaning, you must pay $1,500 in annual medical expenses before Blue Cross begins to pay for your insurance cost . This is Blue Cross. Every PPO Plan is different and covers different types of benefits at varying cost brackets. In some cases optional coverage of dental and vision are not part of the regular PPO Plan and you will have to pay more to have dental and vision benefits covered.
So, taking the case of the Blue Cross 1500 Plan, you will have to pay an annual deductible on your policy of $1500 before BCBS will help you cover your health insurance cost. According to your PPO Plan there could be exception to the rule so it is important that you check your policy benefit booklet to learn how your insurance company covers each type of treatment and prescription.
So, the policy of most PPO Plans in a nut shell is this: after you have payed for your annual deductible any medical cost you have incurred the insurance company will negotiate with your physician or service provider and pay the negotiated amount.
Many policies, however, include a an annual limit out of pocket maximum . This limit will vary with policy. For instance the limit out of pocket maximum will be different for an Individual PPO Plan verses a Family Plan.
Annual Deductible for Individual Plans verses Family
In the case of an individual plan, the annual deductible must be reached based on the medical cost of one individual, while the family plan includes the total cost of all members in the family combined.
Annual Deductible Two Member Max Clause
Pursuant of the policy guidelines, the cost of the deductible can be met by all family members, but there are policies that include a two member maximum coverage. The two member max coverage clause basically states that to reach the annual deductible the two persons covered on the policy must each (separately) meet the deductible amount prior to the insurance company covering their health care cost.
If only one person under the plan has covered their annual deductible, the insurance company will pay for only that person health care cost.
If you are considering purchasing a PPO Plan for you or your family, please take a close look at you benefit handbook, the deductible amount, deductible clause, co-pay and what type of medical treatments that are covered under the policy.
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