Expanded Insurance Options

Fact: More health insurance options results in lower costs.

Another fact: Everyone is different - some people value lower cost; some people value greater provider access. Regardless, families, small businesses and large businesses that provide insurance to their employees should have access to the same menu of health insurance options to meet their needs.

That’s why insurers offer different plans like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPO)s.  

But right now, North Carolina law does not allow the full breadth of options enjoyed in other states.  Exclusive Provider Organizations (EPOs) are currently allowed for small businesses and individuals in most other states – but not here.

EPOs are, however, an option for large companies. That means government regulation is currently preventing small businesses from enjoying the same cost-saving benefits that large businesses enjoy.  

It seems obvious, and only fair, that individuals and small businesses would have the same health insurance options as large companies.

In fact, if the EPO plans available now to large, self-funded companies were offered to small businesses, it could lower monthly premiums by up to 18 percent. 

The General Assembly should change the law so more North Carolinians can access these savings.

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What is an EPO?

An EPO is an insurance plan that lowers premiums by only offering coverage with in-network providers except in the case of emergencies. Since providers know they will get 100 percent of the plan’s business, they will lower their prices – and lower prices mean lower premiums.

Under an EPO, you cannot be denied coverage for preexisting conditions. And the plans cover essential health benefits.

EPOs are designed for greater flexibility. They are great for people who are more inclined to travel for work or pleasure or small businesses that have workers in multiple states – or would if they could provide an EPO as an insurance option. They’re the right plan for people who want lower cost options but need the same health coverage and financial security when they are on the road as they can expect at home. 

EPOs aren’t right for everyone, of course. Some people value greater provider access, and there is nothing wrong with that. There are plenty of options for those people.

Other people and businesses, however, value lower costs while still getting high-quality care. And that’s what EPOs can deliver.