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preferred provider organization (PPO)

1. Type of mixed health-plan model that combines managed care and traditional insurance. Enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health provider designated by their program as a “preferred provider.” They may receive substantial, though reduced, benefits or may have additional cost when they obtain care from a provider of their own choosing who is not designated as a “preferred provider” by their program. 2. A Medicare+Choice coordinated care plan that has a network of providers who have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan. It provides for payment for all covered benefits regardless of whether the benefits are given with the network of providers. It is offered by an organization that is not licensed or organized under state law as a health maintenance organization (HMO). 3. Type of Medicare Advantage Plan in which the patient uses doctors, hospitals, and providers that belong to the network. Patients can use doctors, hospitals, and providers outside of the network for an additional cost.
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An organization of health care providers and/or facilities that offers a discount on services to members of the PPO.

Preferred provider organization (PPO) (Health Insurance)

An alternative to an HMO network available under certain health insurance plans. A network of care providers who treat members of a health insurance plan for a pre-determined fee. The insured may be required to pay a small co-payment while the rest of the charge is usually covered by the plan. This type of network is less restrictive than an HMO, as the insured is free to choose a hospital and physician.

Preferred risk

A risk better than the standard risk on which the premium rate was based.
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Any risk considered to be better than the standard risk on which the premium rate was calculated.
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Exposure an Insurer welcomes because it promises more favorable loss experience than other exposures in the same rating class and, therefore, should generate an Underwriting profit.

Preferred risk class

Category for an insured or applicant of insurance who has a lower expectation of incurring a loss and has greater life expectancy than a standard applicant and qualifies for a reduced premium rate (e.g., applicant who does not smoke, applicant who does not drink). Also called superstandard risk class.

Pregnancy care

Federal legislation enacted in 1978 requiring employers with 15 or more employees who are engaged in interstate commerce and subject to Title VII of the Civil Rights Act of 1964 to give the same benefits for pregnancy, childbirth, and related medical conditions as benefits for other illnesses or injuries.