1. 11498 POINTS
    Jason GoldenzweigPRO
    Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada
    EPO health insurance stands for Exclusive Provider Organization. Under an EPO plan, you can go to a doctor and/or hospital that is in-network. However, there are no out-of-network benefits - meaning you are responsible for 100% of expenses for any visits to an out-of-network doctor or hospital. An advantage with these plans is that you do not need a referral to see a specialist.
    Answered on April 16, 2014
  2. 820 POINTS
    Pete Wittman
    President, The Wittman Group, Tennessee
    EPO is Exclusive Provider Organization.  It is similar to a HMO (Health Maintenance Organization) where they often use a Primary Physician as a gatekeeper to the specialists, where you would need a referral to see a specialist.  The reason it is called exclusive is because if you are under one of these plans, you must exclusively stay in the appointed Network in order to receive benefits.  There is no benefits paid if you go outside the network.  If the state you live in allows EPOs, they are generally regulated under the  insurance laws of the state, unlike HMOs which typically have a different set of regulations.  The states that don not allow EPOs per say, will still allow the plans to be sold under the regulations of HMOs.
    Answered on April 16, 2014
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