Under an EPO plan, members are required to use hospitals and doctors within their own network. Much like a HMO plan, you cannot go outside of your plan’s network for care and you will not be covered if you choose to receive care from an out of network provider. One of the biggest advantages of an EPO plan is the lower cost. EPOs typically cost less than both HMOs and PPOs. Another major perk is that you do not have to get a referral from your primary care doctor to see a specialist.
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EPO vs. POS , which win?
A point of service plan, is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice.
EPO vs POS reviews
Pros of EPO:
- Low monthly premium payments
- No or low deductibles, coinsurance, and copayments
- You do not need referrals
Cons of EPO:
- Fewer provider choices
- Requires pre-authorization
- Plans are harder to find
- Your employees will have the freedom to choose their own PCP, and they can go out of network if necessary.
- The lower copays and premiums are also very appealing for employees.
- Employees also do not have any annual deductible requirements that your employees will need to be concerned about.
- If employees never go out-of-network, then they may end up wasting part of their premiums.
- Deductibles can be costly for employees, and choosing a plan that has annual deductible for out-of-network plan can be confusing and wasteful.
- There is a lot of paperwork involved in a POS plan, particularly if you have to be reimbursed for out-of-network services.