Link to


Child Care Insurance
Dealing with an HMO Dr.
Dealing with your HMO
Dental Insurance
Disability Insurance
EPO Insurance
Family & Medical Leave
Health Insurance

Health Insurance Benefits
Health Savings Account
Help with Denied claims
HMO Plans
HMO Terms Explained
Hospital Indemnity
How Much Insurance
Infertility insurance
Insurance Terms
Life insurance for kids
Life insurance from your job
Long Term Care
Medicaid fraud
MRMI Program
POS Plans
PPO Plans
Risks of not having insurance
Save money on insurance
Term vs. Whole
Universal Life
Workers' Comp


Promote your product

Financial help during medical crisis

Patient assistance programs

Adoption insurance

Value driven health care

Financial Assistance for women's healthcare

2005 Insurance Coverage
2006 Insurance Coverage

62 days after being laid off


EPO Insurance

What is an EPO Insurance Plan?

An EPO insurance plan is a network of individual medical care providers, or groups of medical care providers, who have entered into written agreements with an insurer to provide health insurance to subscribers. Basically, an EPO is a much smaller PPO. EPO insurance plans offer a very limited number of providers who offer large discounts on their rates.

Types of EPO Insurance plans

  1. The current industry standard requires that a patient select a Primary Care Physician and when needed obtain authorization from that Primary Care Physician to receive specialty services. Some patients may not have to choose a Primary Care Physician and only have to choose a medical group. A patient must stay within the contract network and only use preferred providers. There typically is a lifetime policy maximum with this type of plan. If a patient goes out of network they may be responsible for the entire balance that is not paid by the payer associated with the services provided.
  2. The other type of EPO insurance plan is one where the benefits are those of a PPO insurance plan but the provider panel from which members obtain care is smaller than a PPO insurance plan panel.


People who have PPOs have more flexibility to choose a primary care doctor of their own choice. A person with a PPO will also be able to go to a specialist without first having to get an authorization from their primary care physician. EPO members do not receive any reimbursement or benefit if they choose to visit medical care providers outside of the designated doctors and hospitals within the established network. Some EPO insurance plans will give partial reimbursement outside of the network in emergency cases.

Things to think about before joining an EPO

  • Does the organization provide what you think you will need in the future?
  • Do you have any special needs?
  • If you have your own provider or specialists, do they belong to the network or must you switch to the EPO network?
  • Is the EPO reliable?
  • Does the EPO have a history of quality care in your area?
  • Are the charges reasonable, or would you be better served by an insurance plan, especially if the plan is partially paid for by your employer?

We'll teach you how to #LiveTo100!

Join our newsletter!

Accessibility Policy| Terms Of Use| Privacy Policy| Advertise with Us| Contact Us| Newsletter

RSS| Sitemap| Careers

Mamas Health Inc. does not provide medical advice, diagnosis or treatment and use of this website constitutes acceptance of the Terms of Use.

©2000 - 2017 MamasHealth, Inc.™. All rights reserved