Using medical providers in the PPO network reduces deductibles, coinsurance, and total out-of-pocket costs compared to providers outside the PPO network. In a PPO plan, you do not need referrals to see doctors (specialists).
An important difference between In-network and out-of-network providers is that in-network providers bill for services at predetermined contract rates, whereas there is no such control on non-network providers.
Also, note that provider referrals are different than procedure authorizations. PPO doctors, still obtain authorizations if the procedure requires it.
An EPO is the same as a PPO, except there are no benefits for out-of-network providers (except in an emergency). CalCPA Health EPO does not use a gatekeeper/primary care physician (PCP), which some EPO plans in the market require.
With an HMO plan, you select a Primary Care Physician (PCP) within the HMO network of primary care providers. This PCP directs your total care and provides required referrals should you need specialties or services that the PCP does not provide. This PCP role is commonly referred to as a “gatekeeper”. There is no coverage for services for non-PCP providers without referrals, and referrals are typically made within the PCP’s medical group. Out-of-network providers/services are not covered (except in an emergency).
An HSA is a tax-advantaged account designed to help you pay for qualified medical expenses, including medical, dental, vision and medications. HSA plans have two components, a qualified high-deductible health plan (HDHP) and a savings account to make contributions to. Investment earnings on the account are federal tax free (if used for qualified medical expenses). HSA plans help you save for future medical expenses and retirement healthcare costs.
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