Health insurance is one of the most valuable employee benefits. According to a Harris Poll survey, 86 percent of respondents said that receiving comprehensive medical benefits would influence their decision to choose one job over another that did not offer health benefits. The most common types of health insurance plans include HMO, PPO, and EPO. While each has its own set of benefits, exclusive provider organization (EPO) plans are one of the most attractive options. Learn more about EPO insurance, how it differs from other plans, and why you should speak with a health insurance broker.
HMO vs. PPO vs. EPO
Employers have the opportunity to offer their workers a wide variety of health insurance plan options. Understanding what each plan offers is important to ensure that you make the right choice for your business. Health maintenance organizations (HMOs) only cover care that is provided by doctors and hospitals inside of an HMO network. Under an HMO plan, members must get a referral from their primary care physician (PCP) before seeing a specialist. Preferred provider organizations (PPOs) cover care that is provided both inside and outside of the plan’s provider network. With a PPO, members will usually be responsible for a higher percentage of any out-of-network care costs.
Exclusive provider organizations (EPOs) are similar to HMOs as they do not generally cover healthcare that is provided outside of the plan’s provider network. However, unlike HMO members, EPO members are not required to get a referral from their PCP before seeing a specialist. EPO plans are usually more affordable than PPO plans if the member chooses to see a doctor or specialist that is in-network. Although an EPO will not cover out-of-network healthcare, it will usually cover out-of-network costs in the event of a medical emergency.
EPO Insurance Benefits
1. Lower Rates
EPO insurance rates are generally lower than other types of health plans. As EPO contracts are exclusively with specific doctors and hospitals in a network, rates are lower compared to other plans like PPOs. Lower costs are achieved by negotiating favorable reimbursement rates with in-network healthcare providers which results in lower monthly premium payments. Although EPO members have fewer options when it comes to what health providers’ members can see, there is the comfort of knowing that their medical expenses will be reimbursed if members see an in-network provider.
2. Direct Access to In-Network Specialists
If you have employees with chronic health conditions, EPO insurance can be highly beneficial. With an EPO plan, members are not required to get a referral from their primary care physician before seeing a specialist. However, to be fully covered under an EPO plan the specialist must be in-network. The ability to see a specialist without a referral can be a major selling point for employees. Therefore, if you are trying to attract talented workers to your business, offering EPO insurance in your employee benefits package can be a wise choice.
3. PCPs Are Not Required
Unlike other types of health insurance plans like HMOs, EPOs does not require members to have a primary care physician. Although it can be highly advantageous to have a designated PCP, some employees prefer not to have one. This allows more freedom to see different doctors and hospitals that are in-network. However, it is important to convey to your workers that any health services that are received outside of the network will not be covered. When considering if EPO is right for your employees, consider if your workers want to use a PCP or have the convenience of seeing a wide range of physicians.
4. Emergency Coverage
When there is a medical emergency, you want your employees to have the opportunity to see a doctor right away. That is where EPO insurance can come in handy. Although EPO insurance members are not able to see out-of-network healthcare providers without paying for it out-of-pocket, they can receive emergency services from doctors or hospitals that are out-of-network. Similar to an HMO plan, EPO members can see any doctor or hospital – in- or out-of-network – if the illness or injury is considered an emergency. To be considered an emergency in the eyes of the insurance company, the illness or injury must cause severe pain or jeopardize the health of the patient.
Shopping EPO Insurance
An exclusive provider organization is essentially a hybrid between an HMO and a PPO. EPOs typically offers the flexibility that comes with PPOs but with some of the stricter requirements often seen with HMO plans. The price point of EPOs generally falls somewhere between HMOs and PPOs. One of the biggest downfalls of EPO plans is the fairly small network compared to other types of plans. Members may find the list of in-network doctors and hospitals to be relatively short which can be disappointing.
Choosing between the different types of insurance plans can be a little overwhelming. However, the choice will ultimately depend on the unique needs of your employees and the type of benefits your business can reasonable offer. If you are on a tight budget but want to offer your employees health insurance, EPO plans can be beneficial as they offer some of the lowest rates available. However, you will want to consider the limitations that come with EPO insurance compared to more expansive options like HMOs and PPOs. Also take a look at the list of providers in the network when weighing the pros and cons of each option.
Contact a Health Insurance Broker
EPO insurance can be a highly advantageous addition to any employee benefits package. With the freedom to see doctors and other healthcare specialists without a referral, the flexibility to not choose a primary care physician, in addition to the ability to see any in-network provider without an out-of-pocket cost can be attractive features to most employees. However, before making a decision, take the time to compare EPO insurance with other plan options like HMO and PPO. For more information about EPO insurance, contact a professional health insurance broker today.