Small Business

Why Choose a PPO Plan?

Updated on December 12, 2019


As a small business owner, you will make important decisions for your staff – ones that have a significant impact on their lives and the lives of their families. With that heavy responsibility in mind, you’ll want to find out as much as possible about the different kinds of health insurance plans available. For example, what is a PPO plan and how does it benefit your employees? With that knowledge, you can make smart health insurance choices for both you and your company.

What is a PPO Plan?

A Preferred Provider Organization, or PPO, plan is a form of health care insurance plan that works with contracted medical providers. This includes doctors, specialists, urgent care clinics, hospitals and pharmacies. Everything you need may be at your disposal in-network, but with a PPO, you may enjoy more flexibility to pick your own doctors than you might have with others kinds of health insurance plans (like HMO plans, for example).

No Primary Care Provider

Unlike HMO plans, a PPO plan does not require you to choose a primary care doctor as your main point of contact for medical needs. This means your employees can see any in-network doctor they want at any time. By contract, HMO plans generally require you to pick a primary care physician and get referrals if you need to see a specialist or need advanced care like hospitalization.

Staying In Network with a PPO

With a PPO plan, you and your employees must see doctors, hospitals, pharmacies and other medical providers that are contracted with the insurance company’s network, if you want to be covered at the highest level. The insurance company maintains partnerships with these health care entities with a clear understanding about services and pricing structures. In order to be considered as part of the PPO network, medical providers must agree to pre-arranged prices for specific services, usually at a discounted rate. By staying in-network when they receive medical care, your employees can receive many medical services with generally lower out-of-pocket costs.

Going Out of Network

One of the primary benefits of a PPO plan for small business employees is the ability to go out of network, but that choice comes at a cost. Generally, your employees can expect to pay a larger percentage of the bill if they decide to go out of network for healthcare. This means that if your employees are willing to pay more:

  • They are free to pick any doctor to see, even if that doctor is out of network.
  • They can choose any pharmacy they want.
  • They can see a specialist without a referral.
  • They can choose a hospital or clinic they like even if out of network.

To get the most savings, though, they should try to stay in the network as much as possible.

Key Benefits of a PPO Plan

With a PPO plan, your employees get:

  • More flexibility – There are generally no primary doctor referral requirements, so your staff can typically go directly to a specialist without seeing a primary care physician first.
  • Higher out-of-pocket costs and increased paperwork, especially if they go out of network for care.

A PPO plan is more likely to be the right choice for your small business if flexibility to choose your own doctors and see specialists without a referral matters more than cost.

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