What is an Exclusive Provider Organization (EPO) Health Plan?

Exclusive Provider Organization (EPO) health plans are network-based, combining the features of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans to give policyholders the best of both worlds.

How Does an EPO Plan Work?

EPOs cover you based on the healthcare professionals you see and the facilities you visit. That’s why it’s important to make sure a healthcare professional is in your network before getting treatment.

These policies require choosing a primary care physician, who will perform screenings, diagnose new conditions, and treat ongoing illnesses.

One of the hallmarks of this plan is that you do not need your primary care physician’s referral if you want to see a specialist. With most health insurance plans, seeing a specialist almost always requires a referral from a primary care physician.

The advantage of not needing a referral to see a specialist is the ability to get specific treatments faster. When a policy doesn’t require a primary care physician to refer patients to a specialist, it eliminates an entire step in the process. You’ll only have to book one appointment for a specialist instead of one appointment with your primary care physician followed by another appointment with a specialist. However, it’s important to note that you should check to make sure that the specialist you want to see is within your plan’s network.

Will It Cover Out-Of-Network Care?

EPOs do cover out-of-network care, but only in the case of emergencies. If it is a non-emergency situation, your plan will require prior authorization.

How Do the Costs Compare to Other Policies?

EPOs charge smaller premiums, but the deductibles are higher and you’ll pay more for your treatments.

The premiums are small because of the insurance plan’s contracts with healthcare providers within the network. This way, an EPO can work for the best interest of providers and policyholders alike.

Who Is This Ideal For?

EPO plans are ideal for healthier individuals who travel infrequently and are comfortable staying within a network of providers. For someone in good health, the small premiums may be the only expenses he or she will pay, and will only need the coverage in rare instances.

Get The EPO Plan That’s Right for You

At KBI Solutions, we are dedicated to providing you with the health insurance plan that meets your needs. We’re here to make sure that your health coverage will always be affordable, and we are always available to help you in times of need. Call us today at (254) 918-5444.