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Exclusive Provider Organization (EPO) Plans

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Exclusive Provider Organization (EPO)

What is an EPO Plan?

An Exclusive Provider Organization (EPO) is a health plan that offers a large, national network of doctors and hospitals for you to choose from. However, if you choose out-of-network health care providers, it usually will not be covered.

If you choose an EPO health plan, it’s important to know:

  • We recommend you choose a primary care provider (PCP) to act as your personal health advocate and coordinate your health care, but it is not required.
  • If you get medical care outside of your plan’s network (such as a doctor, hospital, clinic or pharmacy that is not a Cigna EPO provider), those out-of-network services are typically not covered under your EPO health plan.
  • In an emergency, you will be covered. However, non-emergency hospital stays other than maternity stays and some outpatient procedures must be approved in advance.