Exclusive Provider Organization EPO

The definition of Exclusive Provider Organization EPO, and how it fits into the Zenefits Health Insurance Marketplace

What is an Exclusive Provider Organization EPO?

An Exclusive Provider Organization (EPO) plan is a type of health insurance plan that combines elements of an HMO plan and a PPO plan. It does not require a Primary Care Physician (like a PPO plan), but there is no out-of-network coverage (like an HMO plan).

 

How does an Exclusive Provider Organization EPO work?

Commonly, EPOs are found in the northeastern US, where the EPO network is usually the tri-state area (but EPOs can exist elsewhere). EPO plans do not require a Primary Care Physician. EPO plans do not have out-of-network coverage (except in emergency situations), like an HMO.