What is an EPO Health Plan?

what is an epo health plan

An Exclusive Provider Organization plan is pretty self-explanatory. It requires members to only visit doctors and hospitals that are within its own network. This type of plan may suit people who live in a big city as it’s likely that they’ll be situated closely to in-network healthcare providers. Conversely, people living in more rural areas might find that distance is a major factor in their choice of healthcare providers and this type of plan simply may not be feasible. Below, we cover more information to help you answer the questions “What is an EPO health plan?” and “how can it benefit your business.”


The Benefits of Exclusive Provider Organization Plans


While this type of plan does seem rather restrictive, they still do have their own unique set of positives. The main demographic of EPO plans are people who don’t anticipate a need for a great deal of medical care, usually younger people. The main allure of an EPO plan is the opportunity to save money.


For people living with chronic health conditions, EPO insurance can also be beneficial. This is because it can allow them to see a specialist without referral from a primary care physician as is the case with HMO plans. The specialist must, of course, be in-network. The chance to access specialist care without a referral is a major selling point for employees.


EPO insurance still lets your employees seek medical attention when there is an emergency. Despite being unable to see healthcare providers that are out of network, EPO members can still receive emergency attention from out of network doctors and hospitals. If the illness or injury is considered an emergency, the EPO insurance will cover the costs.


Benely, Your Group Health Insurance Experts


At Benely, we understand that the world of group health insurance is a complex place. That’s why we’re here to help you and your employees get what’s best for everybody. By partnering with our benefit experts, you and your employees get the peace of mind that comes with having the absolute best health insurance that’s perfect for their unique personal circumstances.