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Plan Options

• Health Plan

• AmeriHealth^® PPO
• AmeriHealth^® HMO
• AmeriHealth^® Point-of-Service (POS)
• Flex Copay Programs
• AmeriHealth^® PPO High Deductible Health Plans
• AmeriHealth Administrators^®

• Supplemental Plan

• AmeriHealth+ HSA Solution
• AmeriHealth+ FSA
• AmeriHealth+ HRA
• Concordia Flex Dental Program
• Concordia Preferred Dental Program
• AmeriHealth^® Vision Program
• Life & Disability Coverages

• Prescription Plan

• Select Drug Program^®
• Standard Prescription Drug Program
• Deductible/Coinsurance Drug Program

FAQ

AmeriHealth^® PPO

What is a Preferred Provider Organization (PPO)?

What is the meaning of in-network/out-of-network benefits?

Can you tell me if my doctor or hospital is in the PPO Network?

How are emergencies covered?

What is a Preferred Provider Organization (PPO)?
PPOs are a combination of fee-for-service and HMO programs. They offer the preventive benefits of an HMO and the freedom of traditional insurance to choose the doctor or hospital you want.

PPOs give you a financial incentive to use in-network (preferred) providers. When you do, a greater portion of the cost of services is covered. But you can opt for out-of-network doctors or facilities and still receive coverage. When you receive care out-of-network, you will be responsible for a deductible and coinsurance. In addition, out-of-network non-paticipating providers may bill you for the differences between the plan allowance and the provider's actual charge.

Unlike an HMO, PPOs do not require you to coordinate your care through a primary care physician or obtain a referral to see a specialist.

What is the meaning of in-network/out-of-network benefits?
When you use a provider that participates in the AmeriHealth PPO Network, they are considered in-network. To find a participating provider, use the online provider search. Providers that do not participate in the AmeriHealth PPO Network are considered out-of-network and higher out-of-pocket costs apply.

Can you tell me if my doctor or hospital is in the PPO Network?
To find a participating provider, use the online provider search.

How are emergencies covered?
An emergency is a medical condition manifesting itself in acute symptoms of sufficient severity that the absence of immediate medical attention could result in serious medical consequences or place your health in serious jeopardy. If you are experiencing symptoms that might reasonably indicate such a condition, then you may need emergency care and should go immediately to the emergency department of the closest hospital. Health concerns of a pregnant woman also may extend to her unborn child. If you believe your situation is life threatening, you should call 911.

Try to notify your personal physician within 48 hours of being treated, or as soon as possible if follow-up care is needed.

Emergency services are paid according to your in-network level of coverage. If you are admitted to an out-of-network hospital, you must notify us within two (2) business days, or as soon as reasonably possible. If you are not admitted to the hospital, you are not required to call us.

If you have additional questions, please go to the Contact Us page to find out where you can direct your questions.