What is a Participating Provider Organization (PPO)?
A Participating Provider Organization is a network of doctors, hospitals and other health care facilities, who have agreed to provide services to plan members.

What is a Participating Provider?
A Participating Provider is a doctor, hospital, or other health care facility who has agreed to participate in the PPO network.

What is a Non-Participating Provider?
A Non-Participating Provider is a doctor, hospital, or other health care facility who has not agreed to participate in the PPO network.

The Participating Provider Organization (PPO) Network you select will be shown on your medical identification card. When you obtain medical care from a Participating Provider, you and the Palmer Health Plan receive additional benefits. The program is easy to use. You may seek care from a Participating Provider or Non-Participating Provider. However, there are advantages when you use Participating Providers. When you receive services from a Participating Provider:

1. Payment is sent directly to that Provider; and
2. They accept the PPO network allowed amount as the most they collect for covered services, less any deductible and/or copay/coinsurance that the member is required to pay.

The Plan pays 90% after deductible for Participating Providers and 60% after deductible for Non-Participating Providers.

All Eligible Expenses received from a Non-Participating Provider are based on the Usual, Customary and Reasonable fee for the geographic area where the services or supplies are received. When using a Non-Participating Provider, the Covered Person is responsible for paying any difference if the billed charges exceed the Usual, Customary and Reasonable Fee. Additional amounts paid do not count toward meeting the Deductible or Out-Of-Pocket Maximum.

Who do I call if I have a question regarding the PPO Network?

For PCC - Davenport, IA Employees contact:

Midlands Choice
1-800-605-8259 or
www.midlandschoice.com

For PCCF - Port Orange, FL or PCCW - San Jose, CA contact:

Beech Street Corporation
1-800-937-2277 or
www.beechstreet.com