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Definition of Group EPO Health Insurance

Individuals and families who want low cost health coverage can apply for Exclusive Provider Organization (EPO) group health insurance. These plans offer access to efficient health care services provided by medical providers. Under group plans, members pay less for insurance coverage and have fewer eligibility requirements to meet than those who apply for individual policies. However, EPO group health plans have restrictions that leave members responsible for paying their medical expenses without insurance help.

  1. EPO Plans

    • EPO plans provide members with low cost health insurance by controlling the costs of medical services. This is done by requiring EPO members to visit doctors within networks provided to them. Insurers negotiate lower rates with the medical providers in exchange for patients. By visiting doctors within their provider network, members pay low co-payments. From their provider networks, members must select Primary Care Physicians (PCPs) who are in charge of their medical decisions. PCPs have the authority to refer their patients to other doctors or specialists for necessary medical services.

    Benefits of Group EPO Health Plans

    • According to MedHealthInsurance.com, EPO group health plans are cheaper than other insurance options, including HMOs. EPOs insure groups of people with similar characteristics, such as age, gender and occupation; one of the main sponsors of these coverages is employers. All eligible applicants are extended coverage without providing evidence of insurability under group plans. Insurance premiums are shared between group members and plan sponsors. This lowers the financial burdens of members; according to the Kaiser Family Foundation, in 2009, employers paid over 70 percent of the premium amounts on average.

    Considerations

    • Individuals and families who benefit the most from EPO group plans are those who are healthy. This is because the plans' provider networks have limited numbers of doctors and specialists. In general, EPO plans provide fewer providers than other health care coverages. It is more likely EPO group insurance policies are available to rural area residents than health plans with larger networks.

    Warning

    • EPO plans do not pay expenses from non-network care yet may cover partial costs if the visits are considered emergencies. In addition to premiums, members also have to pay deductibles. Group EPO health plans are not portable, which means if members leave their jobs, they will lose their insurance coverage. Members also have no input on premium rates and coverage options as these decisions are made by the plans' sponsors.

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