What is the difference between PPO/Basic Plan and EPO Plan?
PPO stands for “Preferred Provider Organization” and is a group of Hospitals, clinics and independent health care practitioners who provide discounted services to the Members of NDPERS. Because PPO Health Care Providers charge Blue Cross Blue Shield of North Dakota less for medical care services provided to the Members of NDPERS, cost savings are passed on to Members by way of reduced Cost Sharing Amounts. If a PPO Health Care Provider is not available in the Member’s area, or if the Member chooses or is referred to a Health Care Provider not participating in the Preferred Provider Organization, the member will receive the Basic Plan benefits. EPO stands for “Exclusive Provider Organization”. At the time of enrollment, the Member selects an EPO and agrees to access Covered Services through a primary care physician. The EPO Health Care Provider must provide or arrange for all Covered Services in order for a Member to receive optimum benefits under the EPO Plan. Benefits will be reduced
