GHI PPO/EPO and PPO/EPO Share - EmblemHealth

Types of Plans: PPO and EPOWhat Kind of Health Plan Are You In?You can see what kind of health plan you are enrolled in by looking on your GHI Member ID cardand your GHI Certificate of Insurance and Certificate Attachment in this Welcome Kit. Thereare four (4) types of programs: GHI PPO (Preferred Provider Option) and PPO Share; GHI EPO(Exclusive Provider Option); and EPO Share.Your Member ID card and your Certificate Attachment will indicate which network of providers isavailable to you. For details about Network and Non-Network Providers, see Choosing Your HealthCare Providers.No referral needed. With GHI’s PPO or EPO programs, you are free to schedule an appointmentwith any network physician—including specialists—without obtaining a referral from yourprimary care physician.There are some important differences between these types of programs, described below.As you read through your Member Handbook, keep in mind the type of program you are enrolledin—PPO and PPO Share or EPO and EPO Share. Some of the information presented may not beapplicable to your specific program.GHI PPO and PPO Share PlansIf you are enrolled in the GHI Preferred Provider Option (PPO) program, you may receive mostcovered services from either the GHI National Network or from Non-Network Providers. However,you will usually maximize your benefits and limit your out-of-pocket expenses by receivingservices from GHI Network Providers. Certain services may be covered only when rendered byNetwork Providers. Your Certificate of Insurance and Certificate Attachment indicate whichservices are covered in-network only.If you are enrolled in GHI PPO Share, you will have the same provider choice as GHI PPO, butwith certain cost-sharing requirements that give you a lower premium cost.GHI EPO and EPO Share PlansIf you are enrolled in the GHI EPO (Exclusive Provider Option), you have the freedom to useany provider in the GHI National Network. With limited exceptions, such as emergency care,your coverage will provide benefits only for covered services rendered by a NetworkProvider. Out-of-network benefits are generally not available.If you are enrolled in GHI EPO Share, you will have cost-sharing requirements that enable youto have the same provider choice through the same network as GHI EPO—at a lower cost.Refer to your Certificate of Insurance for details.Back to Tableof ContentsDownloadClaim FormsRegister at ​ghi.comDirectory of HealthCare Providers4