Accident & Health FundamentalsQuestion 12 of 716
An Exclusive Provider Organization (EPO) plan is best described as a plan that:
a.Pays for care from any licensed provider nationwide because it imposes no network restriction
b.Limits non-emergency coverage to in-network providers but typically does not require a PCP referral
c.Combines Medicare and Medicaid benefits into a single plan for dual-eligible members
d.Requires a primary care physician gatekeeper for every referral and pays partial out-of-network benefits
Explanation
An EPO restricts non-emergency benefits to the in-network panel of providers, much like an HMO, but unlike a traditional HMO it generally does not require a PCP referral to see specialists. Out-of-network non-emergency care is usually not covered.
Law Reference: Plan design – EPOThis topic, taught in full in the California Life & Health Insurance Producer Exam guide. California Life & Health Insurance Producer Exam — Complete Study Guide (2026) — PDF + EPUB, $19.99 · 14-day refund →
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Related questions on this topic
- Which of the following is NOT one of the ten Essential Health Benefits categories that an ACA-compliant individual or small group plan must cover?
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PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)