Exclusive Provider Organizations (EPOs) are individual providers or groups of providers who have entered into written agreements with an insurer to provide health care services to subscribers.
An insurer may not issue a policy or certificate that is subject to an exclusive provider provision until the EPO's plan of operation has been approved by the Agency. An EPO is required to maintain a quality assurance program and procedures for hearing complaints and resolving written grievances from the subscribers.
Florida statute requires applications for approval of an EPO plan of operation to include:
Monitoring of EPOs includes submission of provider networks every 6 months and annual grievance reports.
An EPO may expand their geographic service area by submitting an expansion affidavit and supporting documentation requested by the Agency. When the affidavit and supporting documentation is reviewed and deemed complete, a letter of approval will be submitted to the organization. The affidavit also affirms consistent compliance throughout the expanded network with Florida statute and rule.