It seems obvious, and only fair, that individuals and small businesses would have the same health insurance options as large companies. It’s true in most other states.
But right now, North Carolina state law does not allow what’s called an “Exclusive Provider Organization,” or EPO, health insurance option for individuals or small businesses.
EPOs are allowed for large companies who self-fund their health plans, but not for small businesses or individuals who buy their own insurance.
That means that government regulation is preventing people and small businesses from enjoying the same cost-saving benefits that large businesses enjoy.
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 that lowers premiums.
EPOs are fully ACA-compliant, meaning you cannot be denied coverage for preexisting conditions and the plans cover essential health benefits.
Are these the right health plans for everyone? No. 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.
According to Blue Cross NC, if the EPO plans that are available right now to large, self-funded companies were offered to small businesses, it could lower monthly premiums by up to 18 percent.
If EPOs are good enough for some of our state’s largest and most successful companies, they are good enough for you and our state’s small businesses.
The North Carolina General Assembly should take advantage of this opportunity and change the law so people can have more affordable health insurance options.
After all, options are a good thing – and you should have access to the full menu of health insurance options when choosing the best plan for you.