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USAble Mutual Insurance Company

USAble Mutual Connect PPO®

A Preferred Provider Organization (PPO) is a healthcare system that provides services to members at a discount or fixed fee. As a result of the discounts agreed to by participating (preferred) doctors and hospitals, charges for medical services are lower. The lower charges save money for members, who also avoid filing claims because doctors and hospitals file the claims with USAble Mutual Insurance Company.

To receive discounts and to have claims filed by doctors and hospitals, members must seek treatment from PPO-contracted physicians or facilities.

USAble Mutual Connect PPO Preferred Provider Organization

USAble Mutual Connect PPO is a preferred provider organization offered by USAble Mutual. USAble Mutual Connect PPO assists employers in controlling healthcare costs by offering a network of doctors and hospitals that have agreed to discount their fees.

Through this extensive network of participating doctors and hospitals, the health plan is able to gain access to more attractive pricing arrangements and better management of claims costs. Adding proper utilization management to the mix, USAble Mutual Connect PPO can help control not only the price of healthcare, but also how effectively healthcare services are delivered.

Simply put, USAble Mutual Connect PPO obtains price discounts from doctors and hospitals and then passes them along to employers and employees. The plan offers all the benefits of managed care with fewer restrictions than a traditional HMO. Patients retain their choice of healthcare doctors and hospitals, with built-in incentives for choosing physicians and facilities within the network.

Freedom of Choice

Members may choose any doctors and hospitals they wish from the USAble Mutual Connect PPO network and receive the benefit of negotiated discounts. Members who choose a doctor and hospital outside the network are responsible for a greater percentage of the allowed amounts. For example, if a member usually pays 20 percent of the allowed amount for in-network services, he or she might be required to pay 40 percent of the allowed amount for out-of-network services. Also, if out-of-network services are chosen, the member may be responsible for balance billing (the amount above the allowed amount) by the doctor and hospital.

Affordable Care for Employers and Employees

USAble Mutual Connect PPO offers employers a quality product at a lower cost and provides predictability for the employer, patient and physician or facility. USAble Mutual Connect PPO is truly a plan with something for everyone. Employers realize cost savings, while employees get access to the medical care they need.

Plan Offerings

With a preferred provider organization, major medical protection is not sacrificed. Employers have flexibility in choosing copays, deductibles and coinsurance levels that best fit their group's needs. Also, preventive care benefits can be included. There are no claims to file when using a PPO doctor or hospital, which reduces paperwork.

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