Piedmont Community Health Plan offers a variety of plan options to employer groups. There are numerous options with varying deductible amounts, co-payments, out-of-pocket maximums and coverage types. There are also different funding arrangements depending on the size of the group.
Piedmont Community Health Plan is able to offer larger employers who are self-insured customized benefit designs that satisfy employee medical needs and help save on medical spending through our favorable network agreements. Benefit plan designs can be tailored to meet the specific needs of employers and their employees. Our self-insured arrangement can also offer a cost sharing incentive between the employer and the medical community. If claims costs are below or over a set target claims amount, the savings or additional costs can be shared equally under such cost sharing arrangements.
Fully Insured Plans
Piedmont Community Health Plan offers its fully insured plans through a wholly-owned licensed insurance company, Piedmont Community HealthCare, Inc. The fully insured products utilize the same network, claims processing unit, management and staff as Piedmont Community Health Plan. With our fully insured products, employers can select from a variety of product options and are responsible for a monthly premium amount.
Preferred Provider Organization (PPO) Products
PPO or “open access” products allow members to utilize any participating physicians without a referral. However, pre-certification is required for all facility related services. Piedmont's PPO product designs offer both in and out-of-network benefits.
What is a HMO plan?
The Health Maintenance Organization (HMO) is a plan design offered by Piedmont Community Health Plan and Piedmont Community HealthCare. With an HMO, there is only one level of benefits: in-plan. As long as the member uses providers in the network for covered services, the member receives in-plan or the higher level of benefits. Pre-certification is required for all hospital related services, whether inpatient or outpatient. When the member utilizes providers who are not in the network, the services are not a covered benefit except in cases of emergency or where prior authorization has been granted. HMO plans are focused on integrated care through prevention and wellness.
If you have any questions, please contact Customer Service at 434-947-4463, or toll free at 1-800-400-7247, and choose option 1. We look forward to continuing to provide you and your family with the best value and service in healthcare and wellness.