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 70/50 PPO plan has a $500 individual calendar year deductible and a $1,000 family deductible.The 70/50 PPO plan is only offered by Medical Mutual of Ohio and utilizes the SuperMed Plus provider network.
In this plan, you do not need a referral for specialist services. In-network inpatient, outpatient, and diagnostic services are covered at 70% after the deductible is satisfied. Out-of-network coverage for these services is covered at 50% 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%.