What Is an EPO Insurance Plan?

Out-of-network medical treatment isn't covered by an EPO.

Out-of-network medical treatment isn't covered by an EPO.

Married life can be great, but unexpected things do happen -- often at the worst time. An EPO (Exclusive Provider Organization) Insurance Plan can help prevent you from going bankrupt if you're hit with a surprise illness. An EPO is a health insurance option similar to a PPO (Preferred Provider Organization) but with less flexibility.


EPO rates are typically lower than other types of insurance, such as PPO plans. That's partly because an EPO contracts exclusively with specific doctors, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses.

Out of Network

If you get sick somewhere outside of your network, you could have to pay 100 percent of the bill. However, there are some exceptions made in emergency situations. These vary according to the terms of the specific plan, but an EPO will typically define an emergency as an accident or illness which, if not treated within 24 hours, could jeopardize your life or permanently harm you.


Most EPOs don't require referrals as long as you see an in-network specialist. This means you'll get specialty care faster, and you can get by without a primary care provider. Many of these plans, to make up for the out-of-network problems, also don't limit your maximum lifetime coverage. This means if you get very sick, your insurance won't cut off after a certain amount is paid.

Pros and Cons

If you're healthy, tend to stay in your geographic region, and don't have pre-existing conditions, then you're the type of person EPO's were made for. If you're struggling financially and need rates as low as possible, an EPO can be a good way to get insurance at a low price. However, if you have an illness that might require going out of network, or you travel a lot, having an EPO might backfire on you.

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About the Author

With features published by media such as Business Week and Fox News, Stephanie Dube Dwilson is an accomplished writer with a law degree and a master's in science and technology journalism. She has written for law firms, public relations and marketing agencies, science and technology websites, and business magazines.

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