An Exclusive Provider Organization (EPO) is a type of low-cost health plan that covers eligible services within a certain network. The benefits of choosing an EPO come from its low cost. EPO users have the ability to negotiate lower co-payments and premium costs since business is guaranteed to certain in-network physicians. The drawback of the EPO comes when a patient wants to utilize the help of a specialist who is not within the network. Patients that require out-of-network care typically find that they must pay for any outside care entirely out of pocket when using an EPO. It is important to determine if these benefits and drawbacks make an EPO worthwhile, or if another type of plan would be more beneficial to employees.

An EPO is a part of managed care offerings, and one of the plans that is eligible for the open enrollment period. Healthcare.gov outlines the current Open Enrollment Periods as follows:

For coverage starting in 2014, the Open Enrollment Period is October 1, 2013–March 31, 2014. For coverage starting in 2015, the proposed Open Enrollment Period is November 15, 2014–January 15, 2015. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events.

Since the Open Enrollment Period is currently underway, it is important to determine the best and most affordable health care plan for the upcoming year. Employees that feel secure about their health care are more likely to be loyal their employer.

One factor that may help determine whether or not an EPO is appropriate for you and your employees is to check which providers are included in the network. If you and your employees live in an area where many of the doctors are included in the EPO plan, then there should be little concern over having to utilize out-of-network providers. An EPO can be a cost-effective choice in health care. However, if choosing an EPO may make it difficult to find primary care doctors and specialists in the area, then an HSA may be a better choice. While an HSA has a much higher deductible, it generally works in a similar manner to the EPO, except for the fact that there are out-of-network benefits available and is tax-beneficial. Learn more about HSAs here.

If you are having difficulty choosing the right health plan for you and your company, please contact Employer Advantage Group. We work to develop a personalized healthcare strategy for your business so that it is both cost-effective and beneficial to employees. Do what is best for the health of your staff and their families, and choose the right health care plan today.

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