An exclusive provider organization (EPO) health insurance plan offers the cost savings of an HMO with the flexibility of a PPO. This managed care health plan comprises a network of health care providers that the EPO contracts with at negotiated rates. Similar to other health care plans, members must stay within their network of providers or the EPO will not pay for care, with the exception of emergency situations. Before choosing EPO health insurance, employers should consider the benefits to both employees and the business as a whole.
What Are The Benefits Of EPO Insurance For Employers?
Today’s employers have the opportunity to offer their employees a wide range of health care plans, such as Health Maintenance Organization (HMO), Point-of-Service (POS), and Preferred Provider Organization (PPO) plans. It is important to understand what each of these health care plans offers to ensure that the right choice is made for the business.
Exclusive Provider Organization plans are one of the most common employer-sponsored health plans as they are generally more affordable than PPO plans and offer more flexibility than HMOs. However, there are some downsides to EPOs, such as the inability to get any non-emergency out-of-network care covered.
Some of the top benefits of EPO insurance for employers include the following:
Lower Health Care Costs Than Other Plans
With EPO insurance, certain providers and hospitals contract with an insurance company at negotiated rates which are generally low compared to other health plans like PPOs. By negotiating more favorable reimbursement rates with in-network healthcare providers, members are able to enjoy lower monthly premium payments. In exchange for lower health care costs, members have fewer options when it comes to the health care providers and hospitals that they can visit. However, members also have peace of mind knowing that their costly medical expenses will be reimbursed when they see in-network providers.
Pay For A System Of In-Network Specialists
When employers choose EPO as their preferred health insurance plan, they gain access to a system of highly-qualified in-network specialists that their employees can visit when they are ill or for a wide range of preventive services. Having a specific network of specialists in a localized area helps to ensure that employees will not have to search for providers when they need specific treatments or services. This can be especially beneficial when employees suffer from chronic health conditions that require frequent monitoring and treatment. Under an EPO plan, members are not required to get a referral from their primary care physician (PCP) before seeing a specialist.
Several Advantages For Employees
EPO health insurance can also be beneficial for employees. When employees remain in-network and acquire pre-authorization before undergoing treatments, they can save a significant amount of money. In addition, members do not have to choose a primary care physician, although getting a PCP is usually a good idea. This means that members are free to see whichever in-network provider they want and do not need to stick to a single PCP. In addition, members do not generally need a referral from a PCP to see a specialist. However, members must be careful that they are only seeing specialists that are in-network.
Another major benefit of EPO health insurance for employees is the simple claims process. Employees are not responsible for filing claims or dealing with bills as all care is provided in-network. Under an EPO plan, the in-network health care provider will automatically bill the EPO health plan directly on the member’s behalf based on the care received. The only thing that the member is responsible for is paying the copayment, deductible, and coinsurance. If there are any cost-sharing requirements under the specific EPO plan, know that they will usually be lower than with a PPO plan.
Why Should I Choose EPO Insurance?
Employers are not limited when it comes to employer-sponsored health insurance plans. In addition to EPO health insurance, businesses should also consider offering PPO, POS, and HMO plans for their employees as part of a comprehensive employee benefits package.
- PPO: A Preferred Provider Organization plan involves an arrangement between in-network health care providers with an insurance company for lower fees. This gives members a financial incentive to remain in-network. When a member sees an out-of-network provider, they are responsible for the entire bill up front and can then submit the bill to the insurance company for partial reimbursement. Similar to an EPO, PPO members can see specialists without a referral from their PCP.
- POS: Point-of-Service (POS) plans are similar to PPOs but they require members to choose a PCP from the plan’s network of providers. Similar to a PPO, members can choose to see out-of-network providers with reduced coverage. However, members must get a referral from their PCP before seeing a specialist. POS plans often cover more preventive care services than other plans, including certain health improvement programs such as nutrition and smoking cessation workshops.
- HMO: A Health Maintenance Organization (HMO) is one of the more affordable health plan options but also the least flexible. In exchange for a lower or no co-payment, minimal paperwork, and low premiums, HMO members are required to get a referral from their PCP before seeing a specialist. However, HMOs have a good reputation for covering preventive health services and health improvement programs.
Although no health care plan is right for every business, EPO plans are an excellent choice for most employers. Exclusive Provider Organization plans offer ample flexibility without increased costs as long as members remain in-network.
Speak To An Experienced Benefits Consultant
Choosing the right health insurance plan for a business and its employees is not always easy. The right employer-sponsored health plan can attract and retain employees while also providing the business itself with certain perks including cost savings. However, other health care plans such as PPOs, POSs, and HMOs have similar benefits that should not be overlooked. To learn more about EPO health insurance or any other employer-sponsored health plan, call us at (703) 686-5241 or contact an experienced benefits consultant online at Business Benefits Group.