What is the difference between the EPO and the PPO Plan under PHCS?
The Exclusive Provider Option (EPO) does not provide the insured with an out-of network benefit. What this means is that under the EPO, the insured must pick a doctor, specialist or facility (Hospital) from the network directory. Should the insured receive services from facilities or physicians that are not listed in the Provider Directory, the insured is responsible for all charges incurred. The Preferred Provider Option (PPO) does give the insured an out-of-network benefit. If the insured under the PPO plan receives services from a facility (Hospital) outside of the network directory, the insured must first meet a deductible ($300 per person or $500 per family). Once the deductible has been met, the insurance covers 70% with the maximum out of pocket expense per person per year totaling $1,800 including the $300 deductible.
