Choice Stories

May 23, 2020

PPO Advantages and New Anthem PPO Plans

As you consider health insurance options for yourself -- and for your employees -- you may be wondering what makes one health plan choice the right one for you. This article spotlights PPOs, and offers information about new choices coming in Summer 2020 from Anthem Blue Cross.

What is a PPO?

A preferred provider organization (PPO), also sometimes called a participating provider organization or preferred provider option, is a health care plan with a network of health care professionals who have an agreement with an insurer or a third-party administrator to provide health care at pre-negotiated, reduced rates. The doctors, specialists, and hospitals are considered preferred providers for the health plan with whom they are contracted.

PPO Advantages

PPOs account for more than one-third of the enrollees in small group health plans in California, and more than a quarter of all commercial plan enrollment (individual, small group, and large group). A PPO is attractive to many people because it offers participants greater freedom to seek care from any in- or out-of-network health care provider. Typically, the premiums for PPO coverage are greater than for an EPO or HMO, but for some individuals and families, the added cost is worth it.

There are no required referrals for seeing a specialist when you have PPO coverage. You can book an appointment directly with a doctor. If he or she is in-network, you’ll pay a preferred rate for your office visit or other care. If the specialist is out-of-network, you will pay more. Likewise, if you or your employees need to go to a hospital for care, you can make the appointment yourself; no referral is necessary. If you use a lot of specialists or specialized services, or if you require hospitalization, some people find a PPO is a better choice because it offers greater flexibility.

Networks: In general, PPO networks tend to be broader, which gives you and your employees access to more doctors and hospitals. The Anthem Blue Cross PPO options offered through CaliforniaChoice give you access to three Affordable Care Act (ACA) metal tiers and multiple provider networks, as shown below.

Anthem Blue Cross PPO Networks Bronze Silver Gold
  • Prudent Buyer – Small Group
  • Select PPO
  • Advantage PPO
  • Select PPO
  • Prudent Buyer – Small Group
  • Advantage PPO
  • Select PPO
  • Prudent Buyer – Small Group

Anthem’s Prudent Buyer network is one of the largest health care provider networks in California and nationwide.

New 7/1 Options from Anthem

For groups looking for coverage effective on or after July 1, 2020, CaliforniaChoice is expanding its PPO options available through Anthem Blue Cross. Four new plans are being added – three with access to the Anthem Prudent Buyer network and a fourth offering access to Anthem’s Select PPO network. The new plans are available in the Gold, Silver, and Bronze metal tiers, including one with a Health Savings Account (HSA).

If that isn’t enough, also beginning with coverage effective in July, CaliforniaChoice is offering you and your employees two Triple Tier options. That means you can offer them access to three metal tiers: Bronze, Silver, and Gold plans or Silver, Gold, and Platinum. That gives them even more choices when it comes to in-network doctors, specialists, and facilities plus out-of-network providers, too.

With CaliforniaChoice, one employee might select a Gold tier PPO because of a particular doctor or hospital in the PPO’s network. A second employee might select a Silver tier EPO (Exclusive Provider Organization) plan because it offers a slightly lower premium, but offers direct access to in-network specialists without a Primary Care Physician referral. Another employee who rarely visits the doctor might prefer a Bronze tier HMO. A fourth employee might want a plan with an HSA.

It is your employees’ choice when you offer them access to a private health insurance exchange like the CaliforniaChoice multi-carrier program, which has been helping California small businesses since 1996.

Cost Control for You

The CaliforniaChoice exchange lets you determine how much you want to spend on employee benefits. It’s what is called Defined Contribution.

You decide what you want to contribute toward the cost of your employees’ benefits – a Fixed Percentage (50% to 100%) of a specific plan and/or benefit, or a Fixed Dollar Amount for each employee. Each of your employees then applies your contribution to the health plan he or she prefers. If an employee chooses coverage under a plan that costs more than your contribution, he or she simply pays the difference.

At renewal, you have the option to adjust your premium contribution – up or down – giving you control over your employee benefits cost for another 12 months.

Talk to a Broker to Learn More

If you want to learn more about the PPO, EPO, HMO, and other health plan options available through CaliforniaChoice, talk with your employee benefits agent. If you don’t have one, we make it easy to find a licensed insurance professional. Go here to find one in your area.

Your Beginner's Guide to Choosing a Small Business Employee Benefits Program

Do you need help choosing the right health benefits for your employees?
This guide can help!