MYEYEDR.
Accepted Insurance for NPI 1083176952
Optometrist in Fredonia, WI

NPI Status: Active since April 01, 2019

Contact Information

120 MARTIN DR
FREDONIA, WI
ZIP 53021
Phone: (262) 692-9000

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Accepted Health Plans and Insurance Coverage

This registry outlines the health plan networks and insurance coverage profiles associated with MYEYEDR., a practicing optometrist professional in Fredonia, 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 152 individual coverage options managed by medical networks, including networks like Anthem Blue Cross and Blue Shield, Aspirus Health Plan, and Blue Cross and Blue Shield of Louisiana. 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.

Fitler by Network Type

Anthem Blue Cross and Blue Shield

Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000279475WI055001179475WI055001279475WI055001379475WI0550054
Anthem Bronze Pathway/Lean HSA (+ Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000179475WI055000879475WI055000979475WI055001079475WI0550042
Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055002979475WI055003279475WI055003979475WI055004079475WI0550052
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 Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000679475WI055002079475WI055002179475WI055002279475WI0550046
Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055003179475WI055003379475WI055003679475WI055003879475WI0550056
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 Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000779475WI055002379475WI055002479475WI055002579475WI0550048
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 Pathway/Lean 4000 ($0 PCP Visits + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000379475WI055001479475WI055001579475WI055001679475WI0550044
Anthem Silver Pathway/Lean 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000579475WI055001779475WI055001879475WI055001979475WI0550050
Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055003079475WI055003479475WI055003579475WI055003779475WI0550058
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

Aspirus Health Plan

HMO Bronze $0 Medical Deductible
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010016
HMO Bronze 10000
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010009
HMO Bronze 7500
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010011
HMO Catastrophic 10600 with 3 free PCP visits
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010008
HMO Gold 2000
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010015
HMO Gold 2700
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010007
HMO HDHP Silver 5900
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010013
HMO Silver 6000
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010012
HMO Silver 6600
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010001
POS Bronze 7500
POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020005
POS Bronze 8500
POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020003
POS Silver 6000
POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020001

Blue Cross Blue Shield of Wyoming

BlueSelect Bronze Basic
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070026
BlueSelect Bronze Core
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070004
BlueSelect Expanded Bronze Standard without Kid's Dental
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0170020
BlueSelect Gold Core
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070025
BlueSelect Gold HealthPlus
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070013
BlueSelect Gold Standard without Kid's Dental
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0170017
BlueSelect Silver Classic
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070014
BlueSelect Silver Classic without Kid's Dental
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0170016
BlueSelect Silver HealthPlus
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0070016
BlueSelect Silver HealthPlus without Kid's Dental
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0170021
BlueSelect Silver Standard without Kid's Dental
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ALLOWED Tier

Accepted Plan ID Variations

11269WY0170018

Blue Cross and Blue Shield of Louisiana

Blue Max 70/50 $6700 with 2 $0 PCP Virtual Visits HSA Eligible
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340017
Blue Max 80/60 $1500 with 2 $0 PCP Virtual Visits
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340015
Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340010
Blue Max Copay (PCP) 50/50 $7500 Standardized HSA Eligible
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340024
Blue Max Copay (PCP) 60/40 $6000 Standardized
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340023
Blue Max Copay (PCP) 75/55 $2000 Standardized
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0340022
Blue Saver 60/40 $6100
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0350004
Blue Saver 90/70 $3400
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NOT-APPLICABLE Tier

Accepted Plan ID Variations

97176LA0350003

CareSource (Common Ground Healthcare)

CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030003
CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060023
CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030027
CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060015
CareSource (Common Ground Healthcare) Bronze Standard $7500
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030041
CareSource (Common Ground Healthcare) Bronze Standard $7500 - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060003
CareSource (Common Ground Healthcare) Gold $0 Ded
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030005
CareSource (Common Ground Healthcare) Gold $0 Ded - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060025
CareSource (Common Ground Healthcare) Gold $3300
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030017
CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060006
CareSource (Common Ground Healthcare) Gold Standard $2000
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030043
CareSource (Common Ground Healthcare) Gold Standard $2000 - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060001
CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030023
CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060012
CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030047
CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060011
CareSource (Common Ground Healthcare) Silver Standard $6000
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030042
CareSource (Common Ground Healthcare) Silver Standard $6000 - Vision Exam
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060002

HealthPartners

Oak $1,300 Gold
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130001
Oak $2,000 Standard Gold
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130011

Security Health Plan

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
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
No coverage plans found coordinating with your query criteria.

Coverage Information & FAQs

This provider accepts health insurance plans managed by the following insurance companies: Anthem Blue Cross and Blue Shield, Aspirus Health Plan, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, CareSource (Common Ground Healthcare), HealthPartners, Security Health Plan. You can filter specific policies or search for unique plans using the open dashboard controls located above.
No, current public enrollment indicators show that this provider does not accept standard Medicare program assignments.
MYEYEDR. is enrolled across the following managed care network types: EPO, HMO, POS, PPO.
  • HMO (Health Maintenance Organization): Requires receiving care through the network of clinicians and facilities, often requiring primary doctor referrals to access specialist treatments.
  • PPO (Preferred Provider Organization): Provides flexibility to visit out-of-network clinicians without requiring referrals, though seeking care with in-network providers offers lower out-of-pocket costs.
  • 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.