What is a Health Maintenance Organization (HMO) and how does it work?
A Health Maintenance Organization (HMO) provides health care services to enrolled members through a panel of HMO providers. When you enroll in an HMO, you select a participating PCP for each enrolled family member. You may select any participating PCP from your HMO’s provider directory. Your PCP coordinates your medical care, either by providing that care or by issuing a referral to another provider. With an HMO plan, you generally pay a fixed amount each time you receive care. Coinsurance typically does not apply with an HMO Except in an emergency as defined by the plan, or with previous approval through the plan’s authorization procedures, only services provided by or referred by your PCP will be covered under an HMO.
