Exclusive Provider Organization (EPO) The EPO Plan is a consumer driven health plan with a Health Reimbursement Account offering members a different approach to how you pay for today’s health care with an opportunity to save for your future health care expenses. Related Content However, if you choose out-of-network health care providers, it usually will not be covered. It is a lower-premium, high-deductible health insurance plan, which means you pay less […] An EPO plan may be right for you if: You … exclusive provider organization Managed care A managed care organization similar to a PPO–preferred provider organization in purpose and organization, which allows a Pt to go outside the network for care, but must pay the full cost of the services received; it is similar to an HMO in that primary care physicians act as gatekeepers to a network of other providers, an authorization system, etc. If you choose an EPO health plan, it’s important to know: An exclusive provider organization, or EPO, is a health insurance plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within a certain network. An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network, much like a Health Maintenance Organization (HMO). An exclusive provider arrangement occurs when an organization, in exchange for a payment, agrees to limit the sale, distribution, availability, or use of any competitor’s products, services, or facilities during a special event or in the course of its regular exempt activity.
An Exclusive Provider Organization (EPO) is a health plan that offers a large, national network of doctors and hospitals for you to choose from. There are no out-of-network benefits. An Exclusive Provider Organization combines the flexibility of PPOs as a primary care provider is not needed and has a network of medical care provider. As an EPO member, you cannot go outside your plan’s network for care. Your insurance will not cover any costs you get from going to someone outside of that network. The plan also charges an access fee to the health insurance companies for using its plan like in PPOs. Exclusive Provider Organization (EPO) Plan A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. Also note that there are no out-of-network benefits under an EPO health insurance plan.
EPO stands for "Exclusive Provider Organization" plan.