Provider benefit plan health insurance is a plan under which insurance companies form a network with doctors, hospitals and other health care providers to deliver health care to its insured. Subscribers to these plans, who opt to use preferred providers exclusively, are entitled to a higher level of coverage than the basic health insurance policy provides.
A provider benefit health insurance plan, also known as a PPO, or participating provider organization, is comprised of a network of doctors, hospitals and other health care providers that the insurance provider contracts with and elects to administer benefits to covered persons. These health care professionals agree to provide their services to subscribers at a discounted rate. PPO subscribers enjoy service discounts in exchange for their agreement to only use doctors who are partnered with the network. In turn, the doctors experience an increase in business as a result of subscribers electing to use their services exclusively.
Provider benefit health insurance plans typically cover hospital stays, emergency care, preventive care, prescription drugs, specialist care and outpatient surgery. Provider benefit plan health insurance does not require that the insured has a primary care physician, or get referrals to see a specialist. Some out-of-pocket costs such as coinsurance, deductibles and premiums are required.