When you consider an HNE plan that allows you access to doctors outside of the network, you’ll have to decide whether to go with a PPO or a PPO National plan. What is the difference? Why is there a difference in price? How will my employees use the plan?

The difference between HNE’s PPO and PPO National plans lies in the provider networks. All PPO plans give members access to HNE’s regular PPO network. They can go to providers who are not listed in that network, or out-of-network providers. With a standard HNE PPO, any provider who is not in HNE’s regular PPO Network is considered an out-of-network provider. The billing will reflect the out-of-network price.

A PPO National plan allows in-network access to HNE’s entire PPO network. A member in one of these plans also has access to the MultiPlan/PHCS network, which has different copayment amounts from the regular HNE network. A member who is enrolled in a PPO National network can see providers that are not a part of the HNE network or the MultiPlan/PHCS network. If they go to those providers the service is billed at an out-of-network price.

The table below illustrates the differences in member responsibility for each plan by network.

When you decide which type of PPO to offer to your employees, note that PPO National plans generally have a higher monthly premium rate than regular PPO plans. Before you make a decision on which PPO you would like, ask the employees who will be using the plan whether their providers are in the HNE network, the MultiPlan/PHCS network*, or neither network. This will help you to determine which plan suits your employees’ needs.

*Search the MultiPlan/PHCS network on PHCS.com

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