What is an EPO?

What is an EPO?

• A. Must stay in network but no referral needed.
• B. Open network with out-of-network coverage.
• C. Requires referral for any specialist.
• D. Very high deductible.

Answer: (A)

An EPO, or Exclusive Provider Organization, is a health plan that requires you to use in-network providers to have coverage, but you typically do not need a referral to see a specialist as long as you stay in-network. It usually won’t cover care outside the network except in emergencies. This description—must stay in-network but no referral needed—best captures the essence of an EPO. The other descriptions fit different plan types (open-network with out-of-network coverage describes a PPO; requiring referrals for any specialist describes an HMO; and a very high deductible is not defining of EPOs).

An EPO, or Exclusive Provider Organization, is a health plan that requires you to use in-network providers to have coverage, but you typically do not need a referral to see a specialist as long as you stay in-network. It usually won’t cover care outside the network except in emergencies. This description—must stay in-network but no referral needed—best captures the essence of an EPO. The other descriptions fit different plan types (open-network with out-of-network coverage describes a PPO; requiring referrals for any specialist describes an HMO; and a very high deductible is not defining of EPOs).