EPO

E571966

EPO is a type of health insurance plan that covers services only from a specific network of providers, except in emergencies.

All labels observed (1)

Label Occurrences
EPO canonical 4

How this entity was disambiguated

Statements (30)

Predicate Object
instanceOf health insurance plan type ⓘ
managed care health plan ⓘ
comparedWith HMO ⓘ
POS plan ⓘ
PPO ⓘ
differsFrom PPO by generally not covering out-of-network non-emergency care ⓘ
hasBenefitDesign emergency services covered regardless of network status ⓘ
no coverage or limited coverage for non-emergency out-of-network services ⓘ
hasCostCharacteristic typically has higher cost-sharing than HMO plans in some markets ⓘ
typically has lower premiums than PPO plans with similar benefits ⓘ
hasCoverageRestriction covers services only from a specific network of providers ⓘ
hasException allows out-of-network care in emergencies ⓘ
hasGeographicScope network is usually limited to a defined geographic area ⓘ
hasLegalClassification managed care organization product type ⓘ
hasMemberObligation members must verify that providers are in-network to receive full benefits ⓘ
hasNetworkRequirement members must use in-network providers for covered non-emergency care ⓘ
hasNetworkType exclusive provider network ⓘ
hasPaymentModel uses negotiated rates with in-network providers ⓘ
hasPrimaryCarePhysicianRequirement may or may not require selection of a primary care physician depending on plan design ⓘ
hasReferralRequirement often does not require referrals for specialists within the network ⓘ
hasTargetEnrollee consumers willing to trade provider choice for lower premiums ⓘ
hasUtilizationManagement may require prior authorization for certain services ⓘ
isPartOf U.S. private health insurance system ⓘ
offeredIn employer-sponsored group health insurance markets ⓘ
individual health insurance markets ⓘ
offeredThrough health insurance companies ⓘ
health insurance marketplaces created under the Affordable Care Act ⓘ
regulatedBy state insurance departments in the United States ⓘ
similarTo HMO in restricting coverage to network providers ⓘ
standsFor Exclusive Provider Organization ⓘ

How these facts were elicited

Referenced by (4)

Full triples — surface form annotated when it differs from this entity's canonical label.