For information on what plans are available in your area, please use the Health Plan Search by ZIP Code . PPOs contract with doctors, hospitals, and other providers of care to provide services for an agreed upon charge. Unlike an HMO, where a primary care physician directs all your care, a PPO allows you to select a provider, and a specialist without referral. Generally, there are annual deductibles to meet before the plan will pay benefits. The remaining PPO plans are run by the Associations which contract with various health organizations for preferred provider networks and administering benefits.
Benefits vary by plan.
To enroll in an Association plan, you must belong to and pay the applicable dues to the Association. They also set copayment for the care you receive. The PCP coordinates all your care, including referrals to a specialist. If you go outside of the HMO without a referral from the plan, you will be responsible for the total cost of services, except for emergencies or urgent care services. To qualify for DMHC licensure, HMOs must prove their solvency and provide an adequate health care provider network for the population served.