The EPO option is very similar to an HMO in the way benefits are applied. If you choose the EPO, you must receive treatment from an in-network provider. Only emergency services or urgent services received while out of the service area are covered when provided by out-of-network providers or facilities.
Factors to Consider:
- Large selection of network providers in the United ChoicePlus Network.
- No referrals required for specialty care services.
- No coverage for out-of-network services except for life- or limb-threatening emergency.
- No deductibles to meet.
- All payments are set co-pay amounts.
Prior authorization required for the following services:
- Non-emergency In Patient Hospital Service
- Out Patient Surgery
- Mental Health and substance abuse services
- Durable Medical equipment
For a detailed list, consult the EPO summary of benefits.