Page 60 - The Informed Fed--Hearn (edited 10.29.20)

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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