EPO Medical Plans: Are They Right for Your Employees

People Woman Coffee Meeting Sm

When it comes to medical plans, many of your employees might be more accustomed to Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans ⎼ but have you thought about offering an Exclusive Provider Organization (EPO) plan? 

We know when it comes to figuring out what types of medical plans are right for your employees, you have a lot to consider — and adding one more option can seem daunting. We want to help you sort through the details and get the answers you need to make the decision that’s best for you and your people. 

Here’s some info to help you determine if adding EPO plans could benefit your employees.

How do the plans compare?

EPO health plans only cover medical care within their network of health care providers. This concept isn’t much different from HMOs and PPOs, which also contract with a network of providers to offer lower-cost coverage in-network. 

An HMO usually requires you to get a referral from a primary care doctor to see a specialist and it doesn’t typically cover out-of-network medical care. A PPO allows for a little more freedom ⎼ it doesn’t require referrals and will often cover out-of-network medical costs but at a higher out-of-pocket expense compared to in-network.

EPO plans are a hybrid of the two. What sets the EPO plans apart is the size of their network. Typically, an HMO’s bank of doctors is within a region or state, while PPO and EPO plans are nationwide. With EPOs, you won’t receive coverage outside of your network, and you won’t need a referral to see a specialist. 

What does it cost?

Wanting to find ways to limit your health care cost and your employees’ out-of-pocket expense is understandable. EPO plans can have higher monthly costs than HMOs, but lower monthly costs than PPOs. Deductibles, copays, and other expenses vary with each plan. 

It’s good to give your employees more than one health plan option so they can make a well-informed decision about what’s right for their health care needs and budget.

If you decide to offer EPO plans, let your employees know: 

  • Out-of-network services aren’t covered 
  • They don’t need referrals
  • Where to find the list of in-network providers
  • How and why the cost varies from plan-to-plan

Learn more about plan differences with Aetna’s health guide


Also on Nextep

How to handle insurance during leave of absence Employee leaves of absence from work raise questions, especially about health benefits. Who shoulders the insurance premiums during the leave? Let’s untangle this knot one thread at a time. Paid Leave: Business as Usual Paid leaves are straightforward. Simply maintain regular benefit deductions from their paychecks as […]
Read more
Running a business is exciting, but let’s face it, it comes with its fair share of risks.  That’s why Nextep is thrilled to partner with CoverWallet, bringing you exclusive access to comprehensive commercial insurance designed to keep your company safe and sound. Aon’s enhanced platform is powered by CoverWallet, a digital broker designed to make […]
Read more
Taking Charge of Our Well-Being Amidst the hustle and bustle, it’s easy to overlook one of our most valuable assets—our health. Let’s take a moment to reflect on the importance of preventive healthcare because prevention truly is the best medicine for our well-being. What exactly is preventive healthcare? Well, it’s all about staying ahead of […]
Read more
Need help deciding on benefits? Just call your Health Advocate! Have you ever had a question about your benefits? Honestly, who hasn’t? Nextep Health Advocate program can help. Health Advocate is the nation’s leading healthcare advocacy and assistance company. Their experts help employees and their family members navigate the healthcare system, resolve healthcare and insurance […]
Read more
Empowering Employees to Take Control of Healthcare Expenses Healthcare costs can be a real burden on your wallet, affecting your finances and overall well-being. But don’t worry! With planning and proactive steps, you can take control and save money on your healthcare expenses.  Know Your Health Insurance: First, make sure you understand your health insurance […]
Read more
Did you know that mental health assistance is among the most sought-after employee benefits? (Source: Forbes) Nextep’s Aetna health plans are committed to providing comprehensive coverage for your mental and behavioral health needs. Let’s explore how we can support your healthier mind and body journey using your health benefits. Your mental health is a crucial […]
Read more
Exploring the Benefits of a Health Reimbursement Arrangement (HRA) You may have heard about a health reimbursement arrangement (HRA) as a money-saving option for your benefits, but what exactly is it? Is it right for your company? Let’s break it down. An HRA is a benefit plan where you, as the employer, cover a set […]
Read more
Republished with permission from Health Advocate Pride month is celebrated in June in honor of the 1969 Stonewall uprising in New York City. During that event, the LGBTQIA+ community protested for the right to socialize without harassment.  Today, Pride celebrations continue globally as jubilant expressions of how far the LGBTQIA+ community has come. The events […]
Read more
On January 30, 2023, the federal government announced that the two national emergencies addressing COVID-19, the public health emergency (PHE) and the national emergency, will end on May 11, 2023.  Starting May 12, 2023, health plans and group plan sponsors will no longer be subject to federal requirements for coverage of COVID-19 testing, vaccinations, and […]
Read more
Is your pet insured? How about your identity? We all know the value of the major benefits, such as health, dental, vision, life, telehealth, and disability. But what about some of the lesser-known benefits? You and your employees may be missing out on some significant advantages. Pet Insurance Protect your pets with pet insurance options. […]
Read more
Federally-Approved Qualifying Events You may have heard the term “federally-approved qualifying event” when making changes to your health benefits outside the open enrollment window. Here’s a quick rundown of what that means. Any tax-free employee benefits fall under Section 125 of the IRS code. Because the IRS regulates these benefits, employees are only permitted to […]
Read more
8 Easy Ways to Save Money on Health Care Costs Admittedly, there are many things out of your control when it comes to healthcare costs. But, there are still steps you can take that add up to more dollars in your pocket. Following these tips can help save money on health care costs. Use preventive […]
Read more

Download Our App

Download the Nextep Mobile App in Apple iOS or Google Play