Choice Stories

December 18, 2019

EPO Health Insurance Plan: What You Need to Know

An Exclusive Provider Organization (EPO) may not be as well-known as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO); however, with a bit of research, you might find an EPO is the perfect health insurance plan option for you and your employees.

What’s an EPO?

An EPO is a type of health plan that offers a full-network of doctors and hospitals from which to choose.

Like a HMO, an EPO gives your employees access to a select network of medical providers. If they go to a provider in-network, they have limited out-of-pocket costs. If they go outside of the network, the plan offers limited, if any, benefits and your employees’ costs are higher.

Like a PPO, your employees with EPO coverage don’t need to get a referral from a Primary Care Physician to visit a specialist, so long as the doctor is part of the EPO network.

An EPO in Action

Benefits of an EPO

The most well-known benefit of an EPO is its ability to apply the strengths of both an HMO and a PPO in a single option. An EPO offers more flexibility than an HMO because you don’t need a referral from your primary care physician (PCP) to receive specialist care. An EPO is also priced competitively, frequently offered at more affordable premiums than a PPO. For many, it's a happy medium between an HMO and a PPO.

EPO Plans Available through CaliforniaChoice

The Anthem Blue Cross EPO coverage through CaliforniaChoice includes member access to the Anthem Prudent Buyer Network, which offers 90% of doctors and hospitals in the United States through the national BlueCard® Program. Some of the in-network premier California facilities include:

  • Cedars-Sinai Medical Center
  • John Muir Health
  • Loma Linda University Medical Center
  • Mercy General Sacramento
  • Methodist Hospital of Sacramento
  • Scripps Memorial
  • UCSF Medical Center

Oscar Health offers EPO plans in all four metal tiers through CaliforniaChoice. Oscar’s EPO network in Southern California includes top hospitals and providers in Los Angeles and Orange counties, including:

  • Good Samaritan Hospital (Los Angeles)
  • USC Norris Comprehensive Cancer Hospital and Keck Hospital of USC (Los Angeles)
  • Children’s Hospital Los Angeles
  • Huntington Memorial Hospital (Pasadena)
  • Providence St. Joseph Medical Center (Burbank)
  • UCLA Medical Center
  • Providence Saint John’s Health Center (Santa Monica)
  • Hoag Memorial Hospital (Newport Beach)
  • Mission Hospital (Mission Viejo and Laguna Beach)

Talk With an Agent to Learn More

You can get details on the EPO, HMO, PPO, and other options available to you and your business from an employee benefits agent. If you don’t already have an agent, you can look for one here.

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