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EPO Plan Overview

For your medical health needs, you may elect coverage under the Scripps Medical Plan (EPO) administered by HealthComp Administrators.

EPO Plan

The Scripps EPO plan covers care provided by Scripps Custom Network providers. Services by providers that are not in the Scripps Custom Network are not covered, except in the case of an emergency.

To locate a participating provider, please click the Provider Directory tab on the left side of this page under EPO Medical Plan, or click here.

The table below highlights key benefits and cost of care under this medical option. Refer to your Plan Description on the menu bar to the left for a complete description of benefits, exclusions, limitations and more.

Feature EPO Plan
Who directs and provides your care Scripps Custom Network
(Out of network services not covered)
Annual Deductible $0
Annual Medical Out of Pocket Max
(includes all copayments)
$3,000 per person
$6,000 per family
Lifetime Maximum Unlimited
Primary Care Physician Visit $25 copay ($35 copay if no PCP is designated)
Specialist Visit $40 copay
Hospitalization


Scripps Custom Network
Hospitals only
Outpatient Surgical Facility 100% (after $200 copay)
Inpatient Semi-Private Room 100% (after $300 copay per admission)
Inpatient Physician 100%
Urgent Care $50 copay
Emergency Room $200 copay
(waived if admitted)
Ambulance $150 copay
Health Maintenance and Preventive Services $0 copay
Allergy Treatment

     Testing

     Injections/Serum


$25 copay

$10/visit
Diagnostic Lab/X-Ray Lab & X-Ray 100%

Advanced Imaging*: $150 copay ($450 copay max per calendar year)
Durable Medical Equipment 100% after $300 deductible
Outpatient Treatment
(i.e., PT, OT)
$30 copay
(Precert after 24 combined visits)
Acupuncture
Chiropractic
100% after $25 copay
20 visit combined maximum per calendar year
* Advanced imaging includes CT Scan or CAT Scan, MRI and PET Scan.
Mental Health/Chemical Dependency
Outpatient $25 copay
Inpatient 100% after $300 copay per admission
(Network Only)
 

Copayment and co-insurance paid under Medical Eye Services (MES), Mental Health/Chemical Dependency, Chiropractic, Acupuncture, and prescription copays do not apply to the annual out-of-pocket maximum.