The PPO plan design utilizes the Piedmont Community Health Plan network. This type of plan offers two levels of benefits, in-plan and out-of-plan. When a member utilizes network providers for covered services, they receive in-plan benefits. This is a higher level of benefits as compared to the out-of-plan benefits. Pre-certification is required for all hospital related services, including inpatient or outpatient care and diagnostic testing. When a member receives covered services from providers that are not in the network or without pre-certification, they receive out-of-plan benefits. This is a lower level of benefits which costs the member more out-of-pocket than the in-plan level of benefits.
Members are not required to select a primary care physician with the PPO plans. However, they are required to receive pre-certification for all hospital related services and should contact Piedmont within two business days of all emergency or urgent care visits. By doing so, they will receive in-plan benefits.
The PPO plans are offered to all employer groups with at least two full-time employees.
For more information on the PPO plans offered through Piedmont Community Health Plan or Piedmont Community HealthCare, contact us at (434) 947-4463. You can also click on PPO Frequently Asked Questions for more information.