PPO and EPO Health Insurance Plans

What they are, how they work, and what they mean for your business

Offering a broad array of health insurance options for your employees can be a great way to attract and retain employees. With options to fit their specific health needs and lifestyle, your employees can feel cared for, valued and seen. But, what are the best plan options for your business and workforce? 

Luckily, Blue Cross and Blue Shield of Kansas provides plans tailored to the needs of those we are fortunate to serve. When looking at comprehensive health insurance, many employers look to an EPO or PPO plan. Understanding the benefits and differences between these two options is key in determining what will work for your business and employee needs. 

EPO vs. PPO Plans: Key Differences

Exclusive Provider Organization (EPO) plans offer a network of health care providers, health facilities, and services that are only covered if members use providers within the specific health network (except in cases of emergency). For Blue Cross and Blue Shield of Kansas members, that means having nearly 100% of doctors and hospitals in-network in our 103-county service area, excluding Johnson and Wyandotte counties in Kansas. For providers in the Johnson and Wyandotte county area, members should check to see if a doctor or hospital networks with BCBSKS.

With an EPO plan, employees can expect high-quality coverage at more affordable premiums and ACA preventive services included with no cost sharing. Since EPO plans typically have lower premiums compared to PPOs but the lower costs often mean there is less flexibility in who an employee can see for their care. To recap, with an EPO plan, your employees can expect:

• Network-Only Coverage: Employees must use in-network health care providers to receive coverage, except in cases of emergency.  If emergency care is needed — even outside of the Solutions provider network — employees can go to the nearest hospital and still receive the maximum benefits of your plan.
• Referrals Not Required: Unlike some other plan types, EPO members don’t need referrals to see specialists, as long as the specialist is in-network.
• Cost Savings: Lower premiums and out-of-pocket costs are common features of EPO plans, saving your employees money but still providing access.

Preferred Provider Organization (PPO) Plans, on the other hand, provide greater flexibility and broader care access by covering care from both in-network and out-of-network providers, though out-of-network care generally incurs more costs. These plans are often a better fit for employees who value choice, travel often for work or pleasure, or maybe have greater health care needs. The Blue Choice network is made up of nearly 100% of Kansas doctors and hospitals and acute care facilities. There is also nationwide access available through the Blue Card® program. With the BlueCard PPO network, your employees have access to higher-performing, higher value health care throughout the U.S. Offering a PPO plan to your employees means:

• Out-of-Network Options: Coverage is available for out-of-network care. That means they can see doctors and health care professionals where and when it works for their needs.
• No Referrals Needed: Employees can see specialists without needing referrals, whether in or out of network.
• Higher Premiums: The added flexibility typically comes with higher premiums and out-of-pocket costs.

Why Group Plans Make Sense

Encouraging employees to purchase individual plans on the Marketplace may seem like a cost-saving solution, but it often places a greater financial and logistical burden on the workforce. When you find the right mix of benefit plan options, you and your employees can benefit. By offering a group plan, employers can:

• Attract and Retain Talent: A robust health plan is a key factor for many job seekers.
• Provide Better Coverage: Group plans typically include a wider range of benefits compared to individual plans.
• Flexibility: With both EPO and PPO options available for small groups through Blue Cross and Blue Shield of Kansas, employers can tailor plans to meet the diverse needs of their teams.

Choosing The Right Plan For Your Workforce

Investing in a group health plan is not only a commitment to the well-being of employees but also a strategic decision that can improve business outcomes. Blue Cross and Blue Shield of Kansas has resources and team members dedicated to helping you walk through the options that will work for your specific company and the needs of your employees. 

Use our Provider Finder to find doctors, pharmacies and hospitals participating in each Blue Cross and Blue Shield of Kansas network.