EPO
E571966
EPO is a type of health insurance plan that covers services only from a specific network of providers, except in emergencies.
Statements (30)
| Predicate | Object |
|---|---|
| instanceOf |
health insurance plan type
ⓘ
managed care health plan ⓘ |
| comparedWith |
HMO
NERFINISHED
ⓘ
POS plan ⓘ PPO NERFINISHED ⓘ |
| 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 NERFINISHED ⓘ |
Referenced by (1)
Full triples — surface form annotated when it differs from this entity's canonical label.