What Is an EPO Health Insurance Plan?

September 16, 2021by Alex Strautman

An EPO (Exclusive Provider Organization) may not be as well-known as a HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) (PPO), but it’s often a money- and time-saving coverage option.

What is an EPO?

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

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

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

An EPO in Action

Benefits of an EPO

An EPO combines the strengths of a HMO with a PPO in a single option. It offers more flexibility than a HMO because there’s no need for a referral from your PCP to receive specialist care. An EPO is competitively priced, too. It frequently offers more affordable premiums than a PPO. For many, an EPO is a happy medium between an HMO and a PPO.

EPO Plans Available through CaliforniaChoice

You and your employees can choose from a variety of EPO plans through CaliforniaChoice. Multiple options are available from Anthem Blue Cross and Cigna + Oscar.

The Anthem Blue Cross EPO coverage through CaliforniaChoice includes member access to the Anthem Prudent Buyer Network. The Prudent Buyer Network 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, Los Angeles
  • Children’s Hospital Los Angeles
  • John Muir Health, Northern California
  • Goleta Valley Cottage Hospital and Santa Barbara Cottage Hospital, Santa Barbara
  • Loma Linda University Medical Center, Inland Empire
  • Long Beach Memorial Medical Center
  • Providence Saint Joseph Medical Center, Burbank
  • Sutter Medical Center, Multiple Locations in Northern California
  • Scripps Memorial Hospital, San Diego
  • UCSF Medical Center, San Francisco

Cigna + Oscar offers EPO plans in all four metal tiers through CaliforniaChoice. Its plans include top hospitals and providers in the LocalPlus® and Open Access Plus provider networks.

Some of the in-network premier California facilities include:

  • Adventist Health Glendale and White Memorial Los Angeles
  • Cedars Sinai Medical Center, Los Angeles
  • Children’s Hospital Los Angeles
  • Children’s Hospital Orange County
  • Glendale Memorial Hospital and Health Center
  • Goleta Valley Cottage Hospital, Santa Barbara
  • Good Samaritan Hospital, San Jose
  • Hoag Memorial Hospital Presbyterian, Newport Beach
  • Huntington Memorial Hospital, Pasadena
  • Keck Hospital of USC, Los Angeles
  • Packard Children’s Hospital, Palo Alto
  • Providence Queen of the Valley Medical Center, Napa Valley
  • Providence Saint Joseph Hospital of Orange
  • Providence Saint Joseph Medical Center, Burbank
  • Ronald Reagan UCLA Medical Center, Los Angeles (Open Access Plus only)
  • Santa Barbara Cottage Hospital, Santa Barbara  
  • Shriners Hospitals for Children, Pasadena and Sacramento
  • UC Davis Medical Center, Sacramento
  • University of California Irvine Medical Center, Orange
  • USC Norris Cancer Hospital, Los Angeles

You can view the full provider directory on the CaliforniaChoice website. Searches are available by city or ZIP Code as well as hospital affiliation and other criteria.

Talk With a Broker to Learn More

Learn more about EPO, HMO, PPO, and other options available to you and your employees from your health insurance broker. If you don’t already have a broker, you can look for one here.

Shopping for group health insurance?

This guide compiles a list of common questions you may have before you start offering health insurance coverage.