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SMILE DESIGN DENTISTRY
Accepted Insurance for NPI 1912231663
Dentist - General Practice in New Port Richey, FL

NPI Status: Active since September 29, 2009

Contact Information

4104 LITTLE RD
NEW PORT RICHEY, FL
ZIP 34655
Phone: (727) 376-2666
Fax: (727) 375-2577

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Accepted Health Plans and Insurance Coverage

This registry outlines the health plan networks and insurance coverage profiles associated with SMILE DESIGN DENTISTRY, a practicing dentist professional in New Port Richey, FL. 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 162 individual coverage options managed by medical networks, including networks like Ambetter Health, Ambetter of Alabama, and Anthem Blue Cross and Blue Shield. 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.

Insurance Carrier Navigation Index

Fitler by Network Type

Ambetter Health

Clarity Silver
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL0010031
Complete Gold
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001001149004FL0010025
Complete Gold + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002001049004FL0020021
Elite Bronze
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000449004FL0010017
Elite Bronze + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000449004FL0020015
Enhanced Diabetes Care Silver with $0 Drug Options
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000949004FL0010023
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000849004FL0020020
Everyday Bronze
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000249004FL0010015
Everyday Bronze + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000249004FL0020013
Everyday Gold
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001001049004FL0010026
Everyday Gold + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000949004FL0020022
Focused Silver
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000749004FL0010021
Focused Silver + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000649004FL0020018
Standard Expanded Bronze
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000149004FL0010018
Standard Expanded Bronze + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002000149004FL0020016
Standard Gold
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001001349004FL0010028
Standard Gold + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002001249004FL0020024
Standard Silver
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL001000649004FL0010024
Standard Silver + Vision + Adult Dental
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL002002749004FL0020028
Thrive Silver
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

49004FL0010032

Ambetter of Alabama

Complete Gold
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100015
Complete Gold + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110010
Elite Bronze
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100014
Elite Bronze + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110014
Elite Gold
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100016
Elite Gold + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110015
Enhanced Diabetes Care Silver with $0 Drug Options
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100018
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110018
Everyday Bronze
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100003
Everyday Bronze + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110003
Focused Silver
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100005
Focused Silver + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110005
Standard Expanded Bronze
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100011
Standard Expanded Bronze + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110011
Standard Gold
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100013
Standard Gold + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110013
Standard Silver
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0100012
Standard Silver + Vision + Adult Dental
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

53932AL0110017

Anthem Blue Cross and Blue Shield

Anthem Bronze Essential 10150 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990010
Anthem Bronze Essential 10150 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990008
Anthem Bronze Essential 6500 HSA (+ Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990011
Anthem Bronze Essential 7500 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

17575IN0990009
Anthem Bronze Essential POS 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

17575IN1000002
Anthem Bronze Essential POS 7500 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

17575IN1000001
Anthem Bronze Pathway 10150 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980022
Anthem Bronze Pathway 10600 ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970001
Anthem Bronze Pathway 10600 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970010
Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980014
Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980019
Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970007
Anthem Bronze Pathway 8500 for HSA
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970012
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 Catastrophic Essential (+ Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990004
Anthem Catastrophic Pathway (+ Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980017
Anthem Gold Essential 2000 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

17575IN0990006
Anthem Gold Essential 2200 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990012
Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980021
Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970009
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 Heart Healthy Bronze Essential 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990007
Anthem Heart Healthy Bronze Pathway 4900 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980018
Anthem Heart Healthy Bronze Pathway 6000 ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970002
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 Silver Essential 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990002
Anthem Heart Healthy Silver Pathway 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980013
Anthem Heart Healthy Silver Pathway 5000 ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970006
Anthem Silver Essential 3500 HSA (+ Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990013
Anthem Silver Essential 6000 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

17575IN0990005
Anthem Silver Essential 7000 ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990003
Anthem Silver Essential 7000 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN0990001
Anthem Silver Pathway 4000 ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970005
Anthem Silver Pathway 4000 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970011
Anthem Silver Pathway 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980015
Anthem Silver Pathway 5500 for HSA
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970004
Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980020
Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs)
HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

29276OH0970008
Anthem Silver Pathway 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives)
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

32753MO0980016
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 Dental Family
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN086000329276OH083000332753MO086000390028WI0420003
Anthem Dental Family Enhanced
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN086000429276OH083000432753MO086000490028WI0420004
Anthem Dental Family Preventive
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN086000629276OH083000632753MO086000690028WI0420006
Anthem Dental Family Value
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

17575IN086000529276OH083000532753MO086000590028WI0420005

Solstice Benefits

EssentialSmile Florida - Total Care
EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

43274FL0030002
EssentialSmile Ped 221
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

43274FL0010001
Smile Now Florida - No Waiting Period PPO
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

43274FL0010002

UnitedHealthcare

Lone Star - Smile Now
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

98809TX0690002
Smile Now Arizona - No Waiting Period PPO
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

82011AZ0110001
Smile Now Michigan - No Waiting Period PPO
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

63631MI0140001
Smile Now Ohio - No Waiting Period PPO
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

56726OH0080001
Smile Now Texas- No Waiting Period Plan
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

98809TX0690001
Smile Now Utah - No Waiting Period PPO
PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

97462UT0100001
No coverage plans found coordinating with your query criteria.

Coverage Information & FAQs

This provider accepts health insurance plans managed by the following insurance companies: Ambetter Health, Ambetter of Alabama, Anthem Blue Cross and Blue Shield, Solstice Benefits, UnitedHealthcare. 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.
SMILE DESIGN DENTISTRY 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.