EPO

​The exclusive provider organization (EPO) offers comprehensive coverage for care from network providers only, at a lower monthly cost than the PPO. The EPO does not cover out-of-network care.

blood pressure check

Key features of the EPO include the following.

  • 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 30 percent (their copayment) and the plan pays 70 percent for these services.
  • When the annual copayment maximum amount is met, the plan pays 100 percent of allowable charges for the rest of the calendar year.

Eligibility

Employers may choose to offer the EPO to ministers of the Word and Sacrament and 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 the EPO.

The EPO is not available to those in Pastor's Participation.

Cost of coverage

For medical coverage under menu options, employers may offer either the PPO, the EPO, or the HDHP, any two options, or all three. The employer must contribute at least 50 percent of the cost of Member-only coverage in the lowest-cost option offered — regardless of which option or coverage level the employee elects.

Employees enrolled in menu options may be required to pay

  • the balance of the cost for Member-only coverage; and/or
  • up to 100 percent of the incremental cost of coverage for their eligible family members.

Medical Plan coverage

Employees enrolled in the EPO have access to the Blue Cross Blue Shield (BCBS) network of physicians, hospitals, and other healthcare providers. The EPO requires use of network physicians and hospitals to access

  • preventive care benefits;
  • hospital and medical/surgical coverage;
  • behavioral health benefits; and
  • prescription drug coverage.

The EPO also provides resources to improve well-being.

Services provided by out-of-network providers are not covered.

Preventive care

​For those enrolled in the Medical Plan, the preventive care benefit covers 100 percent of the plan allowance for eligible preventive screenings and immunizations with a network provider and is not subject to a deductible.

Read more

Prescription drug benefits

​Prescription drug benefits are automatically included with all medical options. Benefits are administered by OptumRx, which offers a national network of participating pharmacies, including a mail-order pharmacy, and maintains a formulary of preferred prescription medications.

Read more