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Health Maintenance Organization (HMO)

A Health Maintenance Organization (HMO) plan is a type of medical insurance plan with regulated care that is available to only employees living with its designated network area.

 

What makes an HMO plan unique?

 

  • HMO plans require you to designate a primary care physician (PCP). This PCP will need to refer enrollees to any other doctors/specialists in the local network. Think of the PCP as a "gatekeeper" to using coverage and receiving care.
  • HMO plans are not available to out-of-state employees, or employees who live outside of the carrier's established network area.
  • HMO plans usually cost slightly less per month due to the regulation of care.
  • No out-of-network coverage: services are only covered when performed by in-network providers only (Emergency coverage is the only exception, see: Emergency Coverage).
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