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Exclusive Provider Organization (EPO) Overview

At CDPHP, we take care to make sure the providers you interact with are providing the best care they can. Imagine in-network care with no paperwork, no referrals, and no surprises.

The EPO plan includes:

  • Affordable copayments or coinsurance per visit after meeting your deductible (if any)
  • No claim forms or referrals
  • No charge for certain preventive care, including routine annual exams and screenings
  • Freedom to select your own providers of care within our national network
  • Worldwide coverage for emergency care

How it Works

With an EPO you are not required to select a primary care physician (PCP), although we encourage you to establish a relationship with a network PCP who will coordinate your care and refer you to network specialists as needed. You are responsible for paying a coinsurance or copayment when going for care. Please refer to the benefit materials provided to you at the time of enrollment for specifics on your out-of-pocket costs. These vary according to the plan purchased by your employer group.

FAQs

Q. Do I have access to out-of-network benefits?

A. Members of the EPO only have coverage for care provided within the CDPHP network. This includes access to a national network of 550,000+ providers of care.

 


This summary offers highlights but does not detail all benefits, limitations, or exclusions. It is not a contract and may be subject to change. For more detailed information, a Membership Certificate is available upon request.

Note: The EPO Plan is underwritten by CDPHP Universal Benefits, Inc. (CDPHP UBI). You must comply with CDPHP UBI’s managed benefits program as set forth in the contract to receive the maximum benefits for all services. Failure to do so will result in you being responsible for an additional payment of 50% of the allowed amount up to a maximum of $500 for each service otherwise payable, in addition to the applicable copayment, deductible, and/or coinsurance, unless penalty is waived by rider.