These days, there are numerous types of plans offered by insurance companies for health coverage. With titles like HMO, PPO, and EPO, it’s difficult to decipher what they mean and which type of plan is best suited for you. In this first part of our series we have outlined the basic features of a typical HMO.
Health Maintenance Organizations (HMOs), were one of the first contemporary managed care plans. They are characterized by a network of providers within which members can receive covered care (with certain exceptions outlined in the policy).
If you are a member of an HMO and receive care within their specified network, there is no need to file claim paperwork. However, if you receive emergency care outside of the network a claim may need to be filed in order to receive coverage.
Members will pay a premium (usually monthly) to belong to the organization. Health Maintenance Organizations typically do not charge deductibles for care received in their network, but most plans do charge a modest co-pay for each visit (for example $15 or $30). Because they emphasize preventative care, HMO’s often cover annual physicals and well checks at no charge to the member.
Each member must have a Primary Care Physician (PCP) within the HMO network. This is an important part of the HMO system as a member will need a referral from their PCP in order to see a specialist in most cases.
Of course, it’s always best to consult your Accent Agent when thinking about joining a new plan. We can help you determine which type of plan best fits your life.