Page 60 - The Informed Fed--Hearn (edited 10.29.20)
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physicians to provide your general health care. Any visits to a specialist
               must be referred by your Primary Care Physician (PCP). There is typically
               no coverage for out-of-network care with the exception of emergency
               care. You are not required to pay a deductible, but there are often co-
               pays associated with office visits and prescriptions.
                   PPO--Preferred  Provider  Organization.  This  is  a  group  of
               contracted providers who you can select from. You do not have to name
               one particular provider to be your primary care physician and can visit
               any doctor as long as they are on the preferred provider list. These plans
               vary by state with many different options available around the country.
               You are not required to stay within the network, but the insurer will pay
               more if you do. Typically, your insurance company might pay 80% and
               you would pay 20% if you went to someone on the preferred provider
               list. If you went out-of-network, the insurer might only pay 70% and you
               would have to pay 30%. There are usually deductibles required each year
               and you can also expect to pay copays which are often larger than in an
               HMO.
                   FFS--Fee-For-Service.  The  Fee-for-Service  plans  are  offered
               nationwide  and  all  federal  employees  have  access  to  them.  The  line
               between a PPO and Fee-for-Service plan is fairly blurry. Like the PPO,
               you  can  choose  your  provider  from  an  approved  list.  Your
               reimbursement  is  normally  80%  of  covered  expenses  which  are
               considered  reasonable  and  customary  as  determined  in  the  contract
               between the provider and the insurance company.
                   Comparing an HMO to a PPO or FFS: you have less flexibility and
               more  restrictions  in  an  HMO,  which  results  in  lower  premiums  but
               possibly higher out-of-pocket expenses. The more choices and control
               you have, the more it costs you. Should you choose a traditional plan?
               Much of this decision is driven by how healthy you and your family are.
               Your health will be a guiding factor in choosing the best coverage for
               you. Traditional coverage is designed for people with fairly significant
               health issues. If you have a chronic condition, see a specialist more than



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