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Answered 2011-10-28 01:54:27

The newest kind of health insurance coverage, an Exclusive Provider Organization, more commonly called an EPO requires you to choose an exclusive provider. This exclusive provider will take care of all of your health needs.

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Exclusive Provider Organization (EPO)-insurance plan allows access to health care from a network physician, facility or other health care professional, including specialists, without designating a Primary Physician or obtaining a referral- there is no claim forms or bills. Benefits are available for office visits and hospital care, as well as inpatient and outpatient surgery. Does not provide out of network.


EPO stands for "Exclusive Provider Organization." EPO plans may or may not differ very much from HMO (Health Maintenance Organization) plans. It's sometimes hard to make precise distinctions between these types of health plans since the definitions have changed a bit over the years. Generally speaking, however, as a member of an EPO plan, you can only use the doctors and hospitals within the EPO provider network, but cannot go outside of the network for care. There are no out-of-network benefits. This may be the same with some HMO plans. But while an HMO plan will typically require you to coordinate most of your care through a primary care physician (who then refers you to specialists when needed), an EPO plan may allow you more freedom to decide which doctors you see within the provider network. Work with a licensed health insurance agent to help you find the best type of coverage for your needs.


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