EPO

The exclusive provider organization (EPO) option offers comprehensive coverage for care from network providers, at a lower monthly cost to both you and your employees than the PPO. EPO participants have access to the same Blue Cross Blue Shield national network of physicians, hospitals, and other healthcare providers as employees enrolled in the PPO, and no referrals are needed for care.

The EPO does not cover out-of-network care; however, 97% of current Medical Plan members receive care from network providers.

Coverage details

Here are key details about EPO coverage:

• Members pay a flat copay for most outpatient services, including doctor's office or urgent care center visits; telemedicine consultations; outpatient lab work; X-rays; and physical, speech, and occupational therapy.
• Members pay an annual deductible for in- and outpatient hospital services, surgery, and emergency room visits. When the deductible is reached, members pay 20% (their coinsurance) and the plan pays 80% for these services.
• When the annual total maximum out-of-pocket amount is met, the plan pays 100% of allowable charges for the rest of the calendar year.

Read more details about costs to EPO participants.

Value-added features

The EPO includes unique features — available with all Medical Plan options — that provide exceptional value and promote well-being and wholeness.

• Generous preventive care benefits
• Prescription drug benefits
• Call to Health
  
• Telemedicine benefit
  
• Comprehensive mental well-being benefits, including an Employee Assistance Plan
• Centers of Excellence
  
• Diabetes management program

Personalized support through care navigation

The EPO also includes care navigation, provided in partnership with Quantum Health. Care navigation guides members and their covered family members to high-quality care and helps them make the most of their medical benefits. It enhances the value of medical benefits through the Board of Pensions — at no additional cost to the member or employer.

Eligibility

Employers may choose to offer the EPO to employees who are regularly scheduled to work at least 20 hours a week. There is no work-hour requirement for ministers in self-employed validated service to participate in this coverage option.