Kentucky Health Insurance Practice Exam

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What does EPO stand for in health insurance terminology?

Exclusive Provider Organization

EPO stands for Exclusive Provider Organization in health insurance terminology. An EPO plan is a type of health insurance that requires members to use a network of doctors and hospitals for their healthcare needs. Unlike Health Maintenance Organizations (HMOs), EPOs typically do not require a primary care physician or referrals for specialists, but they do not cover any out-of-network care except in emergencies. This structure allows EPOs to provide lower premiums while maintaining control over the quality and cost of care by managing a defined network of providers.

In an EPO, members must understand that if they seek care outside the network, they will likely have to bear the full cost of that care. This model can lead to significant savings for members who primarily seek care within the designated network of providers. Thus, "Exclusive Provider Organization" accurately describes the focus and limitations of this type of health insurance plan.

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Emergency Provider Option

Essential Plan Organization

Enhanced Provider Option

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