What is a Health Maintenance Organization (HMO) and how is it different from other kinds of health plans?
A HMO is a health plan that typically incorporates the concept referred to as Primary Care Physician (PCP) or Gatekeeper. Most HMO plans require participants to select a PCP. The PCP in return becomes responsible for the coordination of the participants medical care. Included in the PCP/Gatekeeper concept is a requirement that PCPs refer participants to specialists within the same network of physicians (and in many instances the same medical group) as the PCP. Most HMOs do not provide benefits for non-emergency services rendered by physicians and facilities that are not in the HMOs approved network. Typically, HMOs emphasize preventive medical care and, in an effort to encourage participants to take a preventive approach to their individual health, provide a high level of benefit for these services. Unlike other types of health plans, HMOs typically do not require participants to meet annual deductibles or pay a percentage of the cost of their care. Out-of-pocket expenses for most HMO
