Which type of insurance plan reimburses medical services only if patients use contracted providers?

The Exclusive Provider Organization (EPO) is designed to offer a straightforward approach to healthcare coverage, significantly focusing on a closed network of providers. With an EPO plan, insurance reimburses for medical services only when patients seek care from within the designated network of contracted healthcare providers. This means that if a patient receives treatment from a provider outside of the established network, they typically will not have their medical services covered by the insurance plan, except in emergencies.

EPO plans thereby encourage patients to utilize a selective group of providers, which often leads to streamlined services and potentially lower costs for both the insurer and the patient. This structure contrasts with other types of plans, like PPOs, where patients have the flexibility to see out-of-network providers, albeit with higher out-of-pocket costs. Similarly, HMOs require members to choose a primary care physician and get referrals for specialist services, but they also usually cover care outside the network in specific circumstances. POS plans combine elements of both HMO and PPO, allowing patients to choose between in-network and out-of-network providers, but with different cost implications.

This focus on a closed network in an EPO is precisely why it stands out from these other insurance plans.