Which of the following is the BEST description of an Exclusive Provider Organization (EPO)?
Explanation
An Exclusive Provider Organization (EPO) is a managed-care hybrid: like an HMO, it provides coverage ONLY through in-network providers (except in genuine emergencies under the federal 'prudent layperson' standard); like a PPO, it generally does NOT require a primary-care-physician referral to see specialists. The EPO model is regulated as a health care service plan under Knox-Keene if it is a full-service plan. Option B describes a Point-of-Service (POS) plan. Option C describes a traditional fee-for-service indemnity plan. Option D is fabricated; EPOs are private insurance products. The three key managed-care archetypes in California are HMO (PCP+narrow network), PPO (broader, no PCP, out-of-network covered at lower rate), and EPO (narrow, no PCP, no out-of-network).
Law Reference: Cal. Health & Safety Code §1342 (Knox-Keene)Practice all 315 questions free — no signup required.
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