GRACE SCHWANTES
Accepted Insurance for NPI 1073190849
Pediatrics in Minocqua, WI

Q: What managed care network types are accepted by this provider?

GRACE SCHWANTES is enrolled across the following managed care network types: EPO, HMO, POS. HMO (Health Maintenance Organization): Requires receiving care through the network of clinicians and facilities, often requiring primary doctor referrals to access specialist treatments.EPO (Exclusive Provider Organization): Restricts coverage strictly to network providers except for emergency situations, but generally allows seeking treatment from network specialists without an official referral.POS (Point of Service): Bridges elements of HMO and PPO rules. It generally mandates an in-network primary care physician referral for specialized services but retains partial out-of-network lookup allowances at heightened cost tiers.

NPI Status: Active since March 26, 2021

Contact Information

9576 HWY 70
MINOCQUA, WI
ZIP 54548
Phone: (715) 358-1000

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Accepted Health Plans and Insurance Coverage

This registry outlines the health plan networks and insurance coverage profiles associated with GRACE SCHWANTES, a practicing pediatrics professional in Minocqua, WI. Compiled from official data resources, this interface is designed to help you determine if your policy is accepted at this practice location. Currently, the provider is listed across 172 individual coverage options managed by medical networks, including networks like Anthem Blue Cross and Blue Shield, Sanford Health Plan, and Security Health Plan. Please use the filtering dashboard below to search for your specific plan by name, narrow results by a single carrier corporate network, or toggle between plan types (HMO, PPO, EPO) to check your status before coordinating an upcoming clinic visit.

Search Insurance Plans

Filter By Insurance Company

Fitler by Network Type

Anthem Blue Cross and Blue Shield

Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560003

Anthem Bronze Preferred/Broad HSA (+ Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560002

Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560006

Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560005

Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560008

Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560001

Anthem Silver Preferred/Broad 4000 ($0 PCP Visits + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560009

Anthem Silver Preferred/Broad 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560004

Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560007

Sanford Health Plan

Sanford Individual TRUE $1,750

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008001889364ND0090018

Sanford Individual TRUE $10,600

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008001589364ND0090015

Sanford Individual TRUE $3,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008000889364ND0090008

Sanford Individual TRUE $4,750

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008001689364ND0090016

Sanford Individual TRUE $6,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008000789364ND0090007

Sanford Individual TRUE $7,200 HSA Qualified

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008000989364ND0090009

Sanford Individual TRUE Standardized $2,000

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008002889364ND0090028

Sanford Individual TRUE Standardized $6,000

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008002789364ND0090027

Sanford Individual TRUE Standardized $7,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SHPTRUE Tier

Accepted Plan ID Variations

31195SD008002689364ND0090026

Security Health Plan

Enrich $2,000 - 25%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280011

Enrich $3,500 - 30%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI028000238166WI0290005

Enrich $4,000 - 50%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280030

Enrich $5,000 HDHP

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280005

Enrich $6,000 - 40%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280012

Enrich $7,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280013

Enrich $7,500 HDHP

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI028000638166WI0290012

Enrich $9,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI028000938166WI0290013

Enrich Protection

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0280010

Premier $2,000 - 25%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310001

Premier $3,500 - 30%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310002

Premier $4,000 - 50%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310030

Premier $5,000 HDHP

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310004

Premier $6,000 - 40%

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310003

Premier $7,500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310006

Premier $7,500 HDHP

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0310005

Select $2,000 - 25%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180026

Select $3,500 - 30%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180023

Select $4,000 - 50%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180030

Select $5,000 HDHP

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180018

Select $6,000 - 40%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180027

Select $7,500

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180028

Select $7,500 HDHP

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180022

Select $9,500

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180014

Select Protection

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0180008

SimplyOne $2,000 - 25%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270011

SimplyOne $3,500 - 30%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270001

SimplyOne $4,000 - 50%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270030

SimplyOne $5,000 HDHP

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270004

SimplyOne $6,000 - 40%

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270012

SimplyOne $7,500

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270013

SimplyOne $7,500 HDHP

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270005

SimplyOne $9,500

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270007

SimplyOne Protection

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0270008

Enrich $1,500 - 30%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290002

Enrich $2,500 - 20% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290003

Enrich $3,400 - 30% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290014

Enrich $3,500 HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290009

Enrich $4,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290010

Enrich $5,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290011

Enrich $5,500 - 40% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290006

Enrich $750 - 10%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0290001

Premier HMO $1,500 - 30%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140004

Premier HMO $2,500 - 20% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140040

Premier HMO $3,400 - 30% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140045

Premier HMO $3,500 - 30%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140011

Premier HMO $3,500 HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140033

Premier HMO $4,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140012

Premier HMO $5,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140034

Premier HMO $5,500 - 40% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140036

Premier HMO $7,500 HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140037

Premier HMO $750 - 10%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140001

Premier HMO $9,500

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0140044

Premier POS $1,500 - 30%

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150002

Premier POS $2,500 - 20% Copay

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150040

Premier POS $3,400 - 30% HDHP

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150045

Premier POS $3,500 - 30%

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150011

Premier POS $3,500 HDHP

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150033

Premier POS $4,000 - 20% HDHP

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150012

Premier POS $5,000 - 20% HDHP

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150034

Premier POS $5,500 - 40% Copay

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150036

Premier POS $7,500 HDHP

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150037

Premier POS $750 - 10%

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150001

Premier POS $9,500

POS Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0150044

Reliance $1,500 - 30%

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160002

Reliance $2,500 - 20% Copay

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160040

Reliance $3,400 - 30% HDHP

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160045

Reliance $3,500 - 30%

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160011

Reliance $3,500 HDHP

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160033

Reliance $4,000 - 20% HDHP

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160012

Reliance $5,000 - 20% HDHP

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160034

Reliance $5,500 - 40% Copay

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160036

Reliance $7,500 HDHP

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160037

Reliance $750 - 10%

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160001

Reliance $9,500

EPO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

38166WI0160044

SimplyOne $1,500 - 30%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300002

SimplyOne $2,500 - 20% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300003

SimplyOne $3,400 - 30% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300014

SimplyOne $3,500 - 30%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300005

SimplyOne $3,500 HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300009

SimplyOne $4,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300010

SimplyOne $5,000 - 20% HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300011

SimplyOne $5,500 - 40% Copay

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300006

SimplyOne $7,500 HDHP

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300012

SimplyOne $750 - 10%

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300001

SimplyOne $9,500

HMO Group

Market Classification Rank: SHOP (Small Group) Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

38166WI0300013

No coverage plans found coordinating with your query criteria.

Coverage Information & FAQs

What insurance does GRACE SCHWANTES accept?

This provider accepts health insurance plans managed by the following insurance companies: Anthem Blue Cross and Blue Shield, Sanford Health Plan, Security Health Plan. You can filter specific policies or search for unique plans using the open dashboard controls located above.

Is this provider enrolled to accept Medicare?

No, current public enrollment indicators show that this provider does not accept standard Medicare program assignments.

What managed care network types are accepted by this provider?

GRACE SCHWANTES is enrolled across the following managed care network types: EPO, HMO, POS.

HMO (Health Maintenance Organization): Requires receiving care through the network of clinicians and facilities, often requiring primary doctor referrals to access specialist treatments.
EPO (Exclusive Provider Organization): Restricts coverage strictly to network providers except for emergency situations, but generally allows seeking treatment from network specialists without an official referral.
POS (Point of Service): Bridges elements of HMO and PPO rules. It generally mandates an in-network primary care physician referral for specialized services but retains partial out-of-network lookup allowances at heightened cost tiers.