Which statement best describes an EPO (Exclusive Provider Organization)?

• A. Like a PPO but no out-of-coverage, no referrals needed
• B. Requires out-of-network coverage
• C. Covers the same services as a traditional HMO
• D. Has the highest possible premiums

Answer: (A)

Exclusive Provider Organization plans limit coverage to in-network providers and typically do not cover care obtained outside that network (except in emergencies). They often don’t require referrals to see specialists, which adds flexibility similar to a PPO. The description that best fits this is that an EPO is like a PPO in terms of not needing referrals, but it has no coverage for out-of-network care. The other statements don’t fit because EPOs generally don’t cover out-of-network care, aren’t defined by HMOs’ same-services structure, and premium levels vary rather than being inherently the highest.