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 dollar amount you must pay each year for covered medical services before the plan begins to pay benefits.
- EPO deductibles are flat amounts, as shown on Medical Plan Highlights 2025/2026.
- 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.
Watch this video to learn more about deductibles.
Copay
When using a Spring Health network provider for behavioral health care (mental health and substance use disorders), you pay $0 for up to six visits per year. If treatment continues beyond these six visits, regular plan copays apply. Spring Health is the service provider for the Mental Well-Being and Employee Assistance Plan (EAP).
Learn more about Mental Well-Being and 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 (mental health and substance use disorders) 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 2025/2026.
- 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.
Watch this video to learn more about copays.
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 network 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 2025/2026.
- 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).