Exclusive provider organization (EPO)
When you enroll in the exclusive provider organization (EPO), you must use the plan’s national network of physicians, hospitals, and other healthcare providers to receive benefits; the EPO does not cover care received from out-of-network providers except for emergency services.
To better understand the coverage provided under the EPO, it’s important to know these key terms.
Deductible
The deductible is a specified annual dollar amount you must pay for covered medical services before the plan begins to pay benefits.
- EPO deductibles are flat amounts, as shown on Medical Plan Highlights 2024/2025.
- If you enroll any family members, you are responsible for two medical deductibles, one for yourself and one for all your family members combined.
- You can reduce your deductible(s) by completing Call to Health, a well-being program that focuses on the four dimensions of wholeness: spiritual, health, financial, and vocational.
Copay
For mental health care, you pay $0 for up to six visits per year with a Spring Health network provider. If treatment continues beyond these six visits, regular plan copays apply. Spring Health is the service provider for the Employee Assistance Plan (EAP).
Learn more about EAP benefits.
A copay is a flat dollar amount that you pay upfront for certain services when using network providers.
- Except for preventive care, you pay a copay for each network office visit (in-person or virtual): $40 for primary and behavioral health care visits, $60 for visits to a specialist or when seeking care at an urgent care center, and $10 when using the telemedicine benefit.
- There are different copay requirements for certain other covered services, such as X-rays and laboratory tests, as shown on Medical Plan Highlights 2024/2025.
- Copays do not count toward the plan deductible.
- There is a $25 copay for the vision exam benefit.
- There are separate copay amounts for prescription drugs. Read more details.
Coinsurance
Coinsurance is the percentage of the cost for covered services that you pay after you pay the deductible:
- Your coinsurance for network medical services is 20%.
- The EPO does not cover out-of-network care (except for emergency services) or non-formulary prescription drugs.
Total maximum out-of-pocket
The total maximum out-of-pocket is the most you will pay in a year in the form of deductibles, copays, and coinsurance. If your covered out-of-pocket expenses reach the total maximum out-of-pocket amount, the plan will pay 100% of allowable costs for the rest of the year.
- The EPO individual and family total maximum out-of-pocket amounts are shown on Medical Plan Highlights 2024/2025.
- Expenses that count toward the EPO total maximum out-of-pocket include your deductible(s), office visit copays, coinsurance, and prescription drug copays (excluding certain nonessential specialty pharmacy drugs).
Translated resources
Find resources and information translated into Korean and Spanish.
한국어 문서와 양식
(Korean language documents and forms)
Documentos y formularios en español
(Spanish language documents and forms)