EPO and PPO members are not required to select a PCP to coordinate their care but we recommend that you establish a relationship with your physician. All preventive services must be received from an affiliated, in-network provider.

PPOs, Preferred Provider Organizations, are groups of hospitals and/or physicians who, directly or through a third party, develop contractual arrangements with payers to provide a specified set of health care services under defined financial arrangements. EPOs, Exclusive Provider Organizations, are similar to PPOs in their organization and purpose. Unlike PPOs, however, EPOs limit their beneficiaries to participating providers for their health care services.

How you enroll will vary based on your employer. Please contact your employer's benefits office for additional direction or Member Services at the Pre-Enrollment Hot Line at 1-800-722-BLUE (2583) for assistance. You may be eligible for other benefits programs, like dental, prescription drugs, or even flexible spending. Who administers these programs varies based on your employer.

Your Delta Dental PPO plan offers you and your covered family members the flexibility to visit any licensed dentist, and to change dentists at any time without notifying Delta Dental. This flexibility is important if you need dental care while on a business trip, your children are attending college away from home or your personal dentist isn't a member of the PPO network.

A PPO (Preferred Provider Organization) plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service for their policyholders. Generally, the preferred service provider agreed to accept an insurance company's usual and customary payment. If you have a PPO contract, and do not use the preferred service providers, you may find yourself paying more for services rendered by the physician or hospital.

The EPO (Exclusive Provider Organization) plan delivers in-network-only benefits through the national BlueCard PPO network. EPO members must seek care from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency. If care is received from a nonparticipating provider, the claim will not be paid. It is the member's responsibility to confirm that the providers and specialists they are seeing participate in the network.

Bernardo Guarachi, age 45, has made history by becoming the first Bolivian to reach the top of Mount Everest. But from a medical point of view, his achievement has a much higher significance. Bernardo is the best known mountain guide in Bolivia. He has summited Illimani (6490 m), 170 times and of course all the other important mountains in Bolivia and South America including Aconcagua, Chile (6959 m), with no supplementary oxygen.

The more information the PCP sends the better. Please include previous lab and radiology reports as necessary. By including comprehensive information, you will save time because the clinic will not have to request the information prior to granting the appointment.

HMOs typically offer a comprehensive array of benefits with a Primary Care Physician who coordinates and monitors your health care needs. If you want to see a specialist, then your Primary Care Physician determines whether you should be referred to a network specialist to receive benefits under the plan.

In an HMO, the insured's choice of doctors and hospitals is limited to those that have agreements with the HMO to provide care. Exceptions are made in emergencies and when medically necessary. In contrast, an insured in a PPO can use doctors who are not part of the plan and still receive some coverage. In such cases, the insured will pay a larger portion of the bill him/herself and will have to fill out some claim forms.

No, you and your dependents must enroll in the same medical plan. (Exception: If you and your spouse are both employed full-time by Enterprise, each may enroll separately and into different plans.)

The EPO ("Exclusive Provider Organization") plan is set up to allow the PCP to direct the care of all members who sign up with them. If the PCP feels he/she cannot provide the care needed to the patient, approval of a Specialist visit is part of their responsibility in caring for the patient.

UK-PPO and UK-PPO "High" are both preferred provider organization health plans (PPO). The differences between the plans are the premiums, deductibles, copayments and coinsurances that apply for each plan. The UK-PPO High will have a higher premium and higher benefits, such as a lower copayment for physician office visits, a lower deductible and lower coinsurance when compared to the UK-PPO. PPO plans offer coverage for both in-network and out-of-network providers.

a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

We are contracted with selected insurance plan networks, and may add more over time, but it is not feasible for us to be contracted with every patient's insurer. Some insurers impose restrictions on pricing that are based on volume rather that quality of service; while larger healthcare provider groups may be able to offer care at volume rates -- seeing 25-30 patients per day -- we are not able or willing to do so.

Note: This chart is only meant to quickly help you identify the differences between the HIP plans we currently offer. For a comprehensive and detailed listing of medical services that are covered, please refer to the summary of benefits provided online. Please follow this link in order to view the chart. Don't sue us! Fractured Atlas is not an insurance company. We're also not lawyers, brokers, agents, doctors, or anyone else qualified to give professional advice.