HMO Plans

Health maintenance organizations or HMOs are health plans which are prepaid. Members pay their HMO monthly premium in return for coverage of all medical costs, provided the physicians are included in the HMO approved network and the procedures performed are within the scope of coverage. The rates are negotiated at the time of sign up.

A primary care doctor must be chosen by the member. This doctor is expected to plan all medical care and treatment for the member as well as make referrals to the necessary specialists. All expenses for medical services provided to the member outside of the officially approved network or hospitals and providers will are incurred by the member.

The idea behind an HMO is that to keep costs low, it is necessary to provide preventative health care before a member falls ill. HMOs are built upon a network of hospitals and physicians who are interested in providing health care to members in exchange for a monthly charge paid by the HMO.

Members may see their primary care doctor as often as necessary, paying the HMO monthly premium plus a small additional fee per visit or prescription. Most health and wellness services are covered. Members may not go to a medical provider outside of the HMO network. HMOs only take on employer groups, but occasionally a few will accept individuals as members.

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