Exclusive Provider Organization (EPO)

Exclusive Provider Organization (EPO)

EPO plans sit between the restriction of an HMO and the flexibility of a PPO. Employees access a defined network of contracted providers, and out-of-network services are generally not covered outside of emergencies. At the same time, most EPO plans waive the primary care physician gatekeeping and specialist referral requirements that come with HMO coverage, which reduces administrative friction for employees using the plan. The premium typically falls between HMO and PPO pricing, and whether your organization gets the middle-ground rate depends on how the plan was negotiated. That’s where we can help.

Victor Insures You provides group exclusive provider organization insurance broker services for employers who expect their broker to scrutinize EPO carrier pricing, evaluate network stability, and push for terms that provide actual benefits to employees.