Discounts for using in-network providers.

Overview

With a Preferred Provider Organization (PPO), you pay less for care when you use in-network providers - doctors, hospitals, and pharmacies that are part of the PPO network.

The plan also provides coverage when you go to out-of-network providers, but you'll pay more. This plan doesn't require referrals.

How it works

With a traditional PPO plan, you can choose any provider. But if you "step outside the network," your copayment, deductible, and coinsurance costs will be higher - sometimes significantly higher.

Plan tools

  • MyHumana tools
  • MyHumana mobile
  • Printable Humana ID card
  • Preauthorization and Notification Lists

How It Works

The PPO plan is a good choice for people who are willing to have larger paycheck deductions in exchange for lower out-of-pocket costs.

Here's what you need to know about a traditional PPO plan:

  • Your deductible may be lower. With a traditional PPO plan, the deductible is usually lower than a PPO with a spending account.
  • You can choose any provider. With a PPO plan, you decide whether you want to use in-network doctors or not. If you "step outside the network," your copayment, deductible, and coinsurance costs will be higher - sometimes significantly higher.
  • The out-of-pocket limit gives you peace of mind. A PPO plan limits the amount of money you'll spend within the plan year. If you reach this limit, called the "out-of-pocket maximum," the plan pays 100 percent of additional covered expenses during the plan year. You continue to pay copayments.

Out-of-network cost impact

When deciding where to go for your care, it's important to understand how the provider you choose to see can greatly affect your out-of-pocket costs.

Understanding the Out-of-Network Cost Impact
(160 KB) Download PDF
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Plan tools

Here are some Humana tools that may be useful to members who have a PPO plan.

MyHumana tools

Visit your secure Website on Humana.com to:

  • View your plan documents that explain what's covered and what you pay for services
  • Keep track of your claims and healthcare spending
  • Order a replacement ID card
  • Use Humana's MyChoice Tools SM to estimate costs for procedures

To access these tools and more, Log in to MyHumana. If you haven't signed up for your secure Website yet, Register for MyHumana today.

MyHumana Mobile

Humana's mobile resources are designed to support the on-the-go needs of consumers and empower healthcare decisions at the point of service. Resources featured in MyHumana Mobile include: an urgent care finder, a spending account balance viewer, and ID card details. Use your existing MyHumana login to access the resources on your mobile device's browser.

Learn more about MyHumana Mobile

Printable Humana ID card

To get printable proof of your Humana coverage, simply fill out the online form in our Humana ID Card Viewer

Humana Commercial Preauthorization and Notification Lists

These dated documents provide a complete list of services that require preauthorization or prior authorization. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.

January 22, 2011, Commercial Preauthorization and Notification List
(265 KB) Download PDF
English
January 24, 2010, Commercial Preauthorization and Notification List
(97 KB) Download PDF
English
July 10, 2009, Commercial Preauthorization and Notification List
(92 KB) Download PDF
English

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