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.

Medical plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company. Plans contain exclusions and limitations and may not be available in all areas. For costs and details of coverage, see your plan documents. Policy forms: OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC).