What characterizes an "exclusive provider organization" (EPO)?

An exclusive provider organization (EPO) is characterized by limiting coverage to services within a designated network. This means that EPO members must use the physicians, hospitals, and other healthcare providers within this network to receive their benefits. If they choose to go outside of this network for care, they typically will not have coverage, except in emergencies.

This structure helps to control costs and ensures that the network providers offer care at pre-negotiated rates, ultimately benefiting both the insurance company and the insured through cost savings. Understanding this network limitation is crucial for members who need to navigate their healthcare options properly and know where they can receive care without incurring additional charges.