Health Insurance Plans
California PPO Health Insurance
Preferred Provider Organization plans, better known as PPO's, give you the freedom to choose a doctor, specialist or hospital. By visiting one of the thousands of providers available in California you receive a discounted rate (negotiated fee) for the covered services. Unlike an HMO you won't have to pick a primary care physician and will be able to see specialists without a referral.
With California PPO health insurance it is important to use your in-network providers. They are contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out of network provider is not contracted with your health insurance plan. The amount you pay for these services could be up to 50% higher. And, in some cases out-of-network services may not be covered at all.
Give the JC Lewis Insurance family (John, Ben or Jeremy) a call to find out if a PPO insurance plan is right for you or your family, 866-745-9555.
Frequently Asked Questions
Choosing the right plan can be a most difficult task. The best plan for you or your family probably isn’t the best for another. We recommend calling JC Lewis for a personalized discussion so we can quickly help you determine the right coverage. If you would rather not call then here are a couple things you might want to consider:
If you happen to be in between jobs, coming off your parent’s insurance or are in between coverage’s then you might want to consider one of our temporary options. If you have no options for obtaining group coverage through an employer, you may value our long term increased benefit individual and family insurance plans.
Some of our individual and family plans offer basic coverage (primarily inpatient hospitalization and outpatient surgery) to cover you in the event of a serious accident or illness. This coverage will have a lower monthly premium then plans with more comprehensive benefits. It is important to watch for limitations in the plans because providers typically put limits on prescription medications or do not cover them at all. If you want comprehensive coverage then the basic plans are not for you.
Our other insurance plans, in addition to our basic options, offer more comprehensive benefits which may include: primary care visit co-pays, preventive care, brand and generic prescription medication coverage and specialist visit co-pays. These more comprehensive coverage’s have a higher monthly premium than our basic options and are intended for individuals and families who use their coverage on a regular basis or who want coverage that includes prescription and preventive care.
Generally, the higher premium that you pay the less you will have to pay for office visit co-pays and deductibles. If you choose a plan with a high deductible and limited office visit co-pays, typically your monthly premium will be lower. If you plan on using your insurance plan once per year for preventive type services a higher deductible plan might suit you best.
You want to be sure that the doctor or hospital you use is included in the network of doctors on the plan you choose. If you do not have a doctor then you can enroll in either the PPO or HMO network and choose a provider close to your residence. Also it is important to remember that the network providers change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan. Always verify, when making an appointment that your provider is still contracted with your carrier.
Health insurance plans typically place limits on how much a member is required to pay in a given year. This limit is referred to as an out-of-pocket maximum. Once you have satisfied this out of pocket maximum toward your health care plan, the health insurance company typically covers 100% of approved medical expenses for the remainder of the year. If you are mainly concerned with what might happen to you or your family in a serious accident or illness you want to pay attention to your out-of-pocket maximum.
