Exclusive Provider Organization definition

Exclusive Provider Organization. (EPO) means a health insurance issuer's or carrier's insurance policy that limits coverage to health care services provided by a network of providers who are contracted with the issuer or carrier.

Exclusive Provider Organization or “EPO” means a type of managed care health plan where

Exclusive Provider Organization or “EPO” means a type of managed care health plan where members are not required to select a primary care provider or receive a referral to receive services from a specialist. EPOs will not cover care provided out-of-network except in an emergency.

Examples of Exclusive Provider Organization in a sentence

• See the “Prior Authorization, Care Management, Medical Policy and Patient Safety” section for more information.This attachment sets forth Covered Services and exclusions (services not Covered).We will retain any refunds, rebates, reimbursements or other payments representing a return of monies paid for Covered Services.Please also read “Attachment B: Other Exclusions.”How An Exclusive Provider Organization (EPO) Plan Works.

• Note that in a few counties where access to HMOs is limited, a third option, Exclusive Provider Organization (EPO), is available.

• If the Plan is a Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) Plan, they are only eligible to enroll in the Plan if they meet the Plan's geographic service area criteria.

• The District shall offer health insurance with at least one Exclusive Provider Organization (EPO).

• The District shall offer health insurance with at least the following or substantially similar choices: One Exclusive Provider Organization (EPO) Premium payments shall be shared with the District paying the equivalent of seventy-five percent (75%) of the premium for the plan.

• In this section, a Plan that pays providers based upon capitation is called a “Capitation Plan.” In the rules below, “provider” refers to the provider who provides or arranges the services or supplies and “HMO” refers to a health maintenance organization plan, and “EPO” refers to Exclusive Provider Organization.

• In this section, a Plan that bases benefits on a negotiated fee schedule is called a “Fee Schedule Plan.” An HMO and Exclusive Provider Organization (EPO) are examples of network only plans that could use a fee schedule.

• Effective October 1, 1997, payer type codes started to include Point-Of-Service Plan (POS) and Exclusive Provider Organization (EPO).

• As of implementation of the changed plans in 2010, the only such plans are the Preferred Provider Organization (PPO) plan, the Exclusive Provider Organization (EPO) plan, and the Basic Exclusive Provider Plan (Basic EPO) with plan designs attached and identified as PPO, EPO and Basic EPO.

• Exception: A loss of coverage resulting from nonpayment of premium, fraud or intentional misrepresentation of material fact shall not be a Triggering Event.HOW THE PLAN WORKS Exclusive Provider Organization (EPO) ProvisionsOscar NetworkThe Network for this Policy is the Oscar Network.

More Definitions of Exclusive Provider Organization

Exclusive Provider Organization. (EPO) means an Exclusive Provider Organization, as defined in California Code of Regulations, Title 10, Section 2699.6000(r).

Exclusive Provider Organization or "EPO" means any arrangement, other than a health maintenance organization, limited health service organization, voluntary health services plans, or a DHCSP, under which the beneficiary receives no coverage or benefits when utilizing non-preferred providers, except when such an arrangement is shown to be in the best interest of the beneficiaries and has been expressly approved by the Director in writing. WC PPPs are not a form of EPO.

Exclusive Provider Organization. (EPO) means an Exclusive Provider Organization, as defined in Section 2699.6000(r) of Title 10 of the CCR a health insurance issuer’s or carrier’s insurance

Exclusive Provider Organization means a managed care plan organized as an insurer that provides access to nonemergency cover ed health care services only through a contracted panel of participating providers, whose reimbursement includes prepayment, withholds, capitation, or other risk-sharing arrangements;