When you enroll in the exclusive provider organization (EPO), you must use the plan’s national network of physicians, hospitals, and other healthcare providers to receive benefits; the EPO does not cover care received from out-of-network providers except for emergency services.
To better understand the coverage provided under the EPO, it’s important to know these key terms.
The deductible is a specified annual dollar amount you must pay for covered medical services before the plan begins to pay benefits.
A copay is a flat dollar amount that you pay upfront for certain services when using network providers.
A copayment is the percentage of the cost for covered services that you pay after you pay the deductible:
The total maximum out-of-pocket is a set annual dollar amount you pay for covered medical services and prescription drugs, after which the plan pays 100 percent of covered expenses for the rest of the year.