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Georgia Individual Health Insurance PPO Information Page

What is the difference between Georgia indvidual PPO health insurance and other types of Georgia individual health insurance plans?

Before we begin to try to understand the different types of Georgia health insurance, there is a bit of information we need to be familiar with. All insurance plans have certain things in common. It would be helpful to understand what they are so you can see how they apply to each type of insurance.

NETWORK - A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.

OUT OF NETWORK - An out of network provider is any physician, hospital, lab, etc. who does not participate (or "accept") your insurance plan. In the event that you utilize one of these providers, your "out of network" benefit would apply, if your plan includes an out of network benefit. Your out of pocket costs and deductibles are usually higher when utilizing this benefit.

Deductible-This is the portion of any health charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). ALL plans have a deductible. It may be vary form $0 to $10,000, but it's always included in the plan benefits.

Coinsurance- After the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay. In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% of $5000 after the deductible has been met. Then the insured's liability would stop and the insurance company would pay the rest.

Not all plans have coinsurance. Often, you won't find coinsurance in an HMO or POS plan, and often it won't be in an H S A eligible plan.

After the deductible and coinsurance have been met, the insurance company has the liability of any other covered health charges during the plan year.

Now that you have a general definition of insurance terms, let's look at the different types of plans.

The term PPO stand for "Preferred Provider Organization". In order to get more providers to contract (or "accept") with the PPO health insurance plan, insurance companies negotiate higher paying contracts for the physicians, hospitals and other providers. These contracts result in a larger number of providers agreeing to contract with the PPO health plans. However, the since the cost of administering these plans is higher, the insured will often be asked to pay more for the PPO health insurance plan than they would an HMO or POS plan.

A PPO health insurance plan almost always has a deductible, and coinsurance. If you stay within the network, there are also co pays for certain services where the deductible and coinsurance do not come into play. For example, an office visit might be a $20-$60 co pay without regard to a deductible or coinsurance. For a hospital stay, you would be responsible for the deductible and your portion of the coinsurance. A word of caution, the co pays are often not all inclusive. For example, an office visit co pay may mean just covers the physician's portion of the visit. Any lab or x-ray charges, will most likely apply towards your deductible and you would have to pay the charges.

Advantages- A PPO provides a great deal of choice of doctors and hospitals. Because of this, the PPO helath insurance plans have been the most popular plans in the past.
Disadvantages- Monthly health insurance premiums will be higher than HMO or POS plan options. Coverage is not as comprehensive as an HMO or POS and you will experience greater out of pocket expense.

Here are some of the other types of insurance plans that are available in Georgia:
HMO Individual and Group Health Insurance Plans
Open Access HMO Individual and Group Health Insurance Plans
POS Individual and Group Health Insurance Plans
Open Access POS Individual and Group Health Insurance Plans
H S A Individual and Group Health Insurance Plans
Indemnity Individual and Group Health Insurance Plans

 We hope this information is helpful to you. If you would like further information or have questions, please feel free to contact us at Insurance Now and we will spend whatever time is needed to help you make sure that you select the right plan for you.


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Call Holly, Chris or Bob at
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Outside of the Atlanta area,
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