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Contact USA:
Toll Free at
1-800-831-3270
Office Hours: Monday -Friday
7:45am - 9pm EST
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Health Maintenance Organization:
A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles. However, only visits to professionals within the HMO network are covered by the policy. All visits, prescriptions and other care must be cleared by the HMO in order to be covered. A primary physician within the HMO handles referrals.
Prepaid group health insurance plan that entitles members to services of participating physicians, hospitals, and clinics. Emphasis is on preventive medicine. Members of the HMO pay a flat periodic fee (usually deducted from each paycheck) for these medical services:
1. HMO Managing Physician-a new member can select an HMO physician, who is then responsible for providing all of his or her health care needs. If necessary, the managing physician makes arrangements for the member to see a specialist.
2. HMO Copayment-a member may be required to pay an amount in addition to required penodic payments, for example, a $5 flat fee for each visit regardless of how expensive the services may be. Or, for each prescription, to pay a flat amount of $2 regardless of the actual cost.
3. HMO Hospital Services-include, among others, room and board, operating room, laboratory tests, radiation, medications, and physical therapy.
4. HMO Physicians and Surgeons Services in Hospital-include surgeons and related medical specialists, with no copayment.
5. HMO Outpatient Hospital Care-members receive the same services that are provided under Inpatient Hospital Services, as authorized by the managing physician; there is no copayment.
6. HMO Outpatient Health Services Provided at HMO Facility-include physician services, preventive health services, diagnosis and treatment services, skilled nursing facility services, mental health and/or alcohol and drug abuse services, dental care under specific circumstances, and emergency services in and out of the HMO area. A copayment may be required.
HMO exclusions include custodial care, experimental procedures, conveniences not medically related such as television, radio, and telephones, and cosmetic care except for medically necessary reconstruction.
 Or call Toll Free: 1-800-831-3270 , contact or email us!
Advantages of HMOs
Low out-of-pocket costs
With most types of insurance, you are responsible for paying a percentage of the bill every time you receive medical care. Additionally, there may be a deductible that must be met before insurance starts picking up the tab. In contrast, HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. Instead of deductibles, HMOs often have nominal co-payments.
Focus on wellness and preventative care
By reducing out-of-pocket costs and paperwork, HMOs encourage members to seek medical treatment early, before health problems become severe. Additionally, many HMOs offer health education classes and discounted health club memberships.
Typically no lifetime maximum payout
Unlike most health insurance plans, HMOs generally do not place a limit on your lifetime benefits. The HMO will continue to cover your treatment as long as you are a member.
Disadvantages of HMOs
Tight controls can make it more difficult to get specialized care
As an HMO member, you must choose a primary care physician (PCP). Your PCP provides your general medical care and must be consulted before you seek care from another physician or specialist. This screening process helps to reduce costs both for the HMO and for HMO members, but it can also lead to complications if your PCP doesn't provide the referral you need.
Care from non-HMO providers generally not covered
Except for emergencies occurring outside the HMO's treatment area, HMO members are required to obtain all treatment from HMO physicians. The HMO will not pay for non-emergency care provided by a non-HMO physician. Additionally, there may be a strict definition of what constitutes an emergency.
Or call Toll Free: 1-800-831-3270 , contact or email us!
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Contact USA:
Toll Free at
1-800-831-3270
Office Hours: Monday -Friday
7:45am - 9pm EST
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