Health insurance selection is one of the most important decisions a business owner will make on behalf of a company and its employees. According to a survey for America’s Health Insurance Plans (AHIP), 56 percent of U.S. adults with employer-sponsored healthcare benefits stated that suitable health coverage is a major contributing factor in deciding whether or not to remain at their current job.
Today, businesses have many options when it comes to health insurance, such as traditional Health Maintenance Organization (HMO), Point of Service (POS) and Preferred Provider Organization (PPO) plans. However, one of the most popular health plans chosen by employers are Exclusive Provider Organization (EPO) insurance plans.
What Are The Benefits Of EPO Insurance For Employees?
An Exclusive Provider Organization health plan requires a member to use hospitals and providers within its own network. This means that EPO members cannot go outside of their plan’s network for care. Most EPO plans do not offer any out-of-network benefits with the exception of a medical emergency. However, there are several key benefits that workers can enjoy when businesses choose to offer EPO health insurance as part of a comprehensive employee benefits package.
Lower Out-of-Pocket Costs
EPO health plans limit a member’s access to a specific group of physicians and hospitals. In exchange for having a targeted network of physicians within a certain regional health system, providers are able to negotiate better reimbursement rates with the insurance company. This can result in lower premium payments for patients.
This major money-saving benefit is one of the top reasons that businesses and employees alike choose EPOs. Although EPO members may have fewer options when it comes to choosing a provider or hospital, they can find comfort in knowing that their medical expenses will be reimbursed if they receive care from an in-network provider.
More Options For Deductibles And Premiums
To receive insurance coverage through an EPO, members must pay a monthly premium. The cost of this premium is based on a variety of factors, such as the specific plan chosen and the location of the business. Compared to other types of employer-sponsored health insurance plans which can be expensive due to greater freedom to visit out-of-network providers, EPO premiums are often very affordable.
With an EPO, members will also be responsible for paying some of the cost through copays. However, the insurance company will step in and cover some or all of the costs once the member reaches their deductible. With an EPO insurance plan, members have access to more options in terms of premiums and deductibles.
A System Of Providers Working Together
EPOs only allow members to receive care from hospitals or providers that are in-network. While this may be initially seen as a disadvantage, it can also be beneficial for patients. When members receive all of their health care services under a single network of providers, their complete library of patient records are kept together for ample connectivity between providers. This means that any hospital or provider in the network will be able to easily gain access to important medical records and patient history.
Patients within a specified network of providers can also benefit from a more seamless patient experience. Providers are often able to refer patients to other providers in the network for specialized care. While members do not need a referral to see a specialist under an EPO, providers in a network will often work with other providers in the same network to ensure that patients receive the best care possible.
No Referrals Needed For Specialty Treatment
What makes EPO health insurance different from other employer-sponsored health plans is that members are not required to choose a primary care provider (PCP). This means that members can continue seeing any provider they choose for their health care as long as the providers are in the specified network.
In addition, members do not need to get a referral from a PCP to see a specialist. Members have the flexibility to contact providers directly at their discretion for specialty treatment and are free to switch providers as they choose.
Why Should I Offer An EPO Insurance Plan?
Today, many employees rely on their employers for health insurance. There are several different types of employer-sponsored health insurance plans available and no one option is right for everyone. It is important to become familiar with all options available to businesses before making a selection. Some of the most common types of health plans include:
- PPO: A Preferred Provider Organization health plan is a type of managed care plan that provides members with maximum benefits when they visit in-network providers or hospitals. However, unlike an EPO insurance plan, a PPO plan does provide some coverage for out-of-network providers. In addition, PPO members can visit any provider with a referral from their PCP.
- HMO: A Health Maintenance Organization (HMO) provides members with a wider network of providers than many other health insurance plans. Costs are typically low and predictable and there is usually a low deductible or none at all. Some plans require members to choose a PCP; members that see providers out-of-network must pay the entire cost of the medical services.
- POS: A Point-of-Service plan is essentially a hybrid between a PPO and HMO plan. Similar to an HMO plan, members must designate an in-network provider to serve as their PCP. However, like a PPO, patients are permitted to see providers outside of their network for health care services. When venturing out-of-network, patients are responsible for paying the majority of the cost unless they have a referral from their PCP.
While each of these health insurance options has its own set of benefits, EPO plans are considered one of the most advantageous. These plans are pocket-friendly, have low monthly premiums and provide members with the flexibility to see specialists without a referral from a PCP.
Speak To An Experienced Benefits Consultant
Choosing the right health insurance plan for a business is not always easy. Reach out to an experienced benefits consultant today to learn more about Exclusive Provider Organization insurance plans.