What does exclusive provider organization insurance mean?

EPO
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).

What is a PPO Plus Plan?

The PPO Plus plan offers access to a broad provider network that includes both Kaiser Permanente providers and a nationwide network. You also have the freedom to choose any licensed provider at the out-of-network benefit level.

What is the difference between an EPO and a PPO?

A PPO (or “preferred provider organization”) is a health plan with a “preferred” network of providers in your area. An EPO (or “exclusive provider organization”) is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO.

Is it better to have an EPO or PPO?

A PPO plan gives you more flexibility than an EPO by allowing you to attend out-of-network providers. On the other hand, an EPO will typically have lower monthly premiums than a PPO. But, if you’re considering an EPO, you should check approved in-network providers in your area before you decide.

How does an exclusive provider organization work?

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 your network. Your insurance will not cover any costs you get from going to someone outside of that network.

What type of plan is an exclusive provider organization?

An EPO, or Exclusive Provider Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO is usually more pocket-friendly than a PPO plan.

What is the difference between PPO and PPO Plus?

In general the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans, have lower costs, but with fewer choices.

What are the benefits of exclusive provider organization?

EPO Insurance Benefits

Lower Rates. EPO insurance rates are generally lower than other types of health plans.
Direct Access to In-Network Specialists. If you have employees with chronic health conditions, EPO insurance can be highly beneficial.
PCPs Are Not Required.
Emergency Coverage.

Who regulates PPOs?

Department of Managed Health Care
Providers can also get help on our Health Provider Complaint page for complaints about things like improper denial of claims or payment delays. In some cases, Department of Managed Health Care (DMHC) regulates PPOs. For those, you will need to contact DMHC for help.