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In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
Aetna PPO plans. Aetna’s Preferred Provider Organization (PPO) plans let you use any doctor, in and out of network, provided that they accept Medicare and Aetna’s plan terms. Receiving care ...
Thatch details the key differences between PPO and EPO health insurance plans.
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. However, when they use out-of-network providers PPO members are reimbursed at a reduced rate that may include higher deductibles and co-payments, lower reimbursement percentages, or a combination ...
A self-funded plan has fixed components similar to an insurance premium; but in contrast, the self-funded plan pays the claims incurred by the plan participants, and the employer's risk is not capped. Even with stop-loss insurance, the employer still retains one hundred percent of the risk of claims payments in a purely self-funded scenario.
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