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PEP PPO DENTAL PLAN AND SUMMARY OF BENEFITS FOR LIFE INSURANCE MASTER PLAN DOCUMENT PLAN YEAR 2024 (EFFECTIVE JULY 1, 2023, June 30, 2024)Public Employees Benefits Program 3427 Gone Road, Suite 109
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How to fill out exclusive provider organization master

01
Obtain the exclusive provider organization master form from the appropriate source.
02
Fill in your personal information such as name, contact information, and identification number.
03
Provide information about the services you offer as an exclusive provider.
04
Include details about any certifications or qualifications you may have.
05
Submit the completed form to the relevant organization for processing.

Who needs exclusive provider organization master?

01
Healthcare providers who want to be part of an exclusive provider organization network.
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An Exclusive Provider Organization (EPO) Master is a type of health insurance plan that provides services through a network of providers. Members are required to use this network for their medical care and do not receive coverage for out-of-network services except in emergencies.
Organizations that offer an Exclusive Provider Organization plan must file the EPO Master. This includes health insurance companies and other entities providing these plans to consumers.
To fill out an EPO Master, applicants should provide detailed information about the organization, including the network of providers, plan benefits, coverage specifics, and any contractual agreements with providers.
The purpose of the EPO Master is to outline the structure, benefits, and coverages of the Exclusive Provider Organization, ensuring that the plan meets legal and regulatory standards while informing consumers and providers.
The EPO Master must report detailed information about the plan's provider network, coverage options, plan limitations, member responsibilities, and contact information for member services.
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