Covered California Certified Enroller Practice Exam

What is one key feature of EPO plans regarding specialist care?

1. Members must choose a Primary Care Physician (PCP)

2. Referrals are required for in-network specialists

3. No referrals are needed for in-network specialists

4. Only urgent care is allowed without a referral

The correct answer is: No referrals are needed for in-network specialists

EPO plans, or Exclusive Provider Organization plans, are designed to offer flexibility and access to a wide network of healthcare providers while maintaining some structure. One of the key features of EPO plans is that members do not need referrals to access in-network specialists. This allows members greater autonomy in managing their healthcare, as they can directly seek specialist services without first needing approval or a referral from a Primary Care Physician (PCP). This streamlined access can be beneficial for individuals who may require specialist consultations frequently or wish to make quick healthcare decisions based on their needs. The requirement in other types of plans, such as HMO plans, for a PCP and referrals, makes the EPO plan structure distinct and appealing for those preferring more straightforward access to specialists. This clarity in access helps members manage their healthcare needs with less bureaucracy and can often lead to quicker treatment options, as they are not held up by additional steps in the referral process.