With the EPO Plan option, you can use any doctor, clinic, hospital or health care facility in the network. There is no coverage if you go out of the network, except in emergencies.
Key Highlights
- Preventive care services are covered at 100 percent when you see in-network providers.
- Primary care office visits have a flat copay of $30 and specialist visits have a flat copay of $50.
- Prescription drug costs are more predictable, most having a copay-based benefit.
- If your doctor’s already in-network, or you are flexible about where you get care and can easily stay in-network, then choosing the EPO may mean a lower cost for you each month.
Exceptions to the “In-Network” Requirement
In the event of a true emergency, going out-of-network may be covered under the EPO Plan. If you are experiencing an emergency such as a stroke or heart attack, go to the nearest emergency room whether or not it is an in-network provider. Most EPOs will cover the cost of emergency care received at the nearest out-of-network facility as though it was in-network care. However, if you need to be admitted to the hospital from the ER, UnitedHealthcare may ask the out-of-network ER to transfer you to an in-network hospital.