Benefits Education

What Does "PPO" Mean, and How Does In-Network vs. Out-of-Network Work?

A PPO—Preferred Provider Organization—is a type of provider network that lets you see both in-network and out-of-network providers, with lower costs when you stay in network. LifeX group health benefits use the PHCS PPO, a national network. The main advantage of a PPO is flexibility: you're not locked into network-only care the way you would be with some other network types.

In-network vs. out-of-network

In-network providers have agreed to the network's negotiated rates, so your costs are lower when you use them. Out-of-network providers haven't, so you generally pay more—but with a PPO, you can still use them.

On a PPO, out-of-network care typically works like this: you meet your deductible, then pay a coinsurance percentage on the out-of-network services. That's different from network types that simply don't cover out-of-network care at all (outside of emergencies). The specific in-network and out-of-network amounts are set out in your Summary of Benefits and Coverage.

How to use your network

The practical steps are simple:

  • Carry your member ID card (available electronically in your Employee Wellness Hub). The PHCS logo on the card tells providers which network to bill.
  • Before a non-emergency visit, confirm your provider participates—our guide on checking the PHCS PPO network shows you how.
  • If a provider's office is unfamiliar with the network, the eligibility line can verify benefits and speak with the office directly.

Why the PPO flexibility matters

Because a PPO covers out-of-network care (at a higher cost share rather than not at all), you have options if a specialist you need isn't in network, or if you're traveling. That said, staying in network is almost always cheaper, which is why confirming participation up front is worth the two minutes.

The bottom line

A PPO gives you in-network and out-of-network options, with the lowest costs in network. Use your ID card, confirm providers participate before non-emergency care, and check your Summary of Benefits and Coverage for the cost-sharing details that apply to your plan.

This article explains how PPO networks generally work and is not a description of any specific plan's benefits. For your specific cost-sharing, see your Summary of Benefits and Coverage and plan documents.