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Q. What is the difference between a PPO and HMO?
While an HMO is generally a less expensive option, it is significantly more restrictive.  You must select a primary care physician (PCP) and prior to going to a specialist, you will need to see your PCP and get a referral.  As says, “keep in mind that most HMOs are for-profit businesses. They have to make money somehow, and often this means that doctors must see as many patients as possible each day and minimize costs for the organization.”

A PPO will allow you much more flexibility.  Instead of being forced to see your PCP if you are in need of a specialist, you can go freely.  It allows a patient more control over their coverage, but you should always be careful to try to stay in network to minimize your out of pocket expenses. 

Q. What age can my dependent be covered until?
All dependents are covered up until age 19, regardless if they are in school or not.  Upon reaching age 19, they can be covered up until age 23, as long as they are a full-time student (proof is required by the Plan).

Do I have a deductible?
Not if you visit an in-network provider.  If you do happen to go out-of-network, there is a deductible, so you should reference the schedule of benefits, as it is determined by the Plan and Coverage you have selected.

Once I select a Plan (NCA Pro PPO, NCA Plus PPO), can I later decide to change?
You can freely move down plans whenever you would like (i.e. from NCA Pro PPO to NCA Advantage PPO).  You cannot, however, move up quite as easily (i.e. from NCA Advantage PPO to NCA Pro PPO)..  You will need to provide proof that you are not doing so with a known illness requiring better coverage.

How are out-of-network claims paid?
That partly depends of the plan you select, though all are based on a percentage of what is considered Reasonable & Customary.  For instance, if you are on the diamond plan, once you have reached your deductible the plan will cover 70% of what is deemed Reasonable & Customary.

How do I confirm my claims have been paid?
In order to follow-up on the status of your claims, you should contact the Plan’s TPA, Maloney Associates, at 1-800-334-3680.

How do I find a doctor in my network?
We have provided links to all the networks here on the site, which you can use to find an in-network provider.  If you are unsure, please feel free to contact the Plan Administrator for further assistance.

We recommend that you always call the doctor to confirm, no matter what other information you are told.  Doctors are consistently enrolling and leaving networks and it is impossible to maintain the most up-to-date information.