Final answer:
In a California EPO plan, Health Net acts as the medical group, providing a network of doctors and hospitals. Members must use these in-network services to be covered, typically without the need for specialist referrals. Such plans may offer lower costs compared to PPOs.
Step-by-step explanation:
In a California Exclusive Provider Organization (EPO) plan, Health Net functions similarly to a medical group. This means that Health Net will provide a network of doctors and hospitals from which plan members are required to seek their healthcare services. Unlike a Preferred Provider Organization (PPO), where members have some coverage even if they go outside the network, EPO plans typically do not offer any coverage for services rendered by out-of-network providers, unless in case of an emergency.
When enrolled in an EPO plan, members often do not need referrals to see specialists within the network. However, it is essential to confirm that services and providers are within the network before receiving care to ensure coverage. Additionally, EPO plans may offer lower premiums and out-of-pocket costs compared to PPO plans, while still providing a range of healthcare options within their network.