This prefix is associated with an EPO plan. Exclusive Provider Organization coverage combines elements of HMO and PPO plans: members must stay in-network like an HMO, but can self-refer to specialists like a PPO. Out-of-network services are not covered except for emergencies.
Traditional indemnity coverage means the member has fee-for-service insurance with no network limitations. Any licensed provider can be seen without referrals. Claims are reimbursed based on usual, customary, and reasonable (UCR) charges. The member typically pays a deductible and a percentage of allowed charges.
PPO coverage under this prefix means the member can access any provider. In-network providers have negotiated rates with the plan, while out-of-network providers are reimbursed based on usual and customary charges. Prior authorization is generally not required for routine services but may be needed for high-cost procedures.
Independent licensee providing commercial, Medicare and Medicaid plans to Tennessee members.