Exclusive Provider Organization (EPO)
EPO plans offer a higher level of choice and flexibility than many other managed care plans. Members can see any provider in the EPO network, which contains family and general practitioners as well as specialists in all areas of medicine. There is no need to choose a primary care physician and no referrals are necessary to see a specialist. An EPO provides members with an extensive local, national, and worldwide network of providers. There are no claim forms to file and members will never have to pay more than the co-payment for covered services.
There is no out-of-network coverage.
POS plans offer the freedom to use either a network provider or an out-of-network provider for medical and hospital care. If the subscriber uses a network provider, health care delivery resembles that of a traditional HMO, with prepaid comprehensive coverage and little out-of-pocket costs for services.
When the subscriber uses an out-of-network provider, health care delivery resembles that of an indemnity insurance product, with less comprehensive coverage and subject to deductibles and/or coinsurance.
Participating Provider Organizations (PPO)/Indemnity Plans
These plans offer the freedom to use either a network provider or an out-of-network provider for medical and hospital care. PPO/Indemnity Plans contract with health care providers who agree to accept a negotiated lower payment from the health plan, with co-payments from the subscribers, as payment in full for medical services.
When the subscriber uses a non-participating provider, the subscriber is subject to deductibles and/or coinsurance.