PPO Plan Designs
through Preferred Health Systems of Kansas, Inc.
With this type of plan design, if you or your employee sees a doctor from a pre-selected group of network providers, you receive a discounted, pre-negotiated rate. If go outside of the network, you pay a higher percentage of the costs.
Pre-existing Condition A pre-existing condition provision may apply if medical services are received during the first 90 days after the effective date of coverage and medical advice, care or treatment, or diagnosis was made or received for the same condition 90 days prior to the effective date of coverage. The provision will not apply if you and/or your dependent(s) have been covered under another health insurance policy within 63 days prior to the effective date of this coverage, without a gap in such coverage. This provision will not apply to pregnancy or to a child who is enrolled in the plan within 30 days after birth, adoption, or placement for adoption.
Providers Preferred Health Systems Insurance Company is offering a Preferred Provider Organization (PPO) benefit plan through the Preferred Health Care network of Contracting Providers or its affiliated contracting networks. A Covered Person may utilize any provider. If a Contracting Provider is utilizes, the Covered Person will receive the Network level of benefits. If the Covered Person utilizes a Non-Contracting provider, the Covered Person will receive the Non-Network level of benefits. The Covered Person will also be responsible for the difference between the actual billed charges of a Non-Contracting Provider and the PHSIC allowed amount(s).