An HMO plan offers healthcare services through a network of providers. Members must choose a primary care physician who provides referrals for specialists. HMO plans typically have lower out-of-pocket costs than other plans but provide less flexibility in choosing doctors. They require use of in-network providers and provide coverage for preventive services without a deductible. HMOs may be a good option for those who prefer lower premiums and good preventive care coverage.

1. What is an HMO?

2. Tell me about… HMOs
HEALTH MAINTENANCE ORGANIZATION (HMO) INSURANCE

3. The Breakdown of an HMO Plan
 HMO means "Health Maintenance Organization."
 HMO plans offer a wide range of healthcare services through a network of
providers who agree to supply services to members.
 With an HMO you'll likely have coverage for a broader range of preventive
healthcare services than you would through another type of plan.

4. How does an HMO plan work?
Variations
 Many variations, but
typically it enables
members to have lower
out-of-pocket healthcare
expenses,
 But also less flexibility in
the choice of physicians
or hospitals than other
plans.
Requirements
 May require you to
choose a primary care
physician (PCP).
 A referral is required to
see a specialist from their
PCP.
 May not be required to
pay a deductible before
coverage starts and your
co-payments will likely be
minimal.

5. HMOs
Claim Submissions?
You also typically won't
have to submit any of
your own claims to the
insurance company.
No Coverage?
No coverage for services
rendered by out-of-network
providers or for services
rendered without a proper
referral from your PCP or in
cases of certain emergency
situations.
Preventive Services
HMOs generally provide
coverage for a broader
range of preventative
services than other policies.
Employees may or may not
be required to pay a
deductible before their
coverage starts, and will
usually have a copayment.

6. An HMO may be a
good option for
an
individual/family
or a small
business if you:
• PREFER LOWER PREMIUMS
• LIKE THE TRADE-OFF OF IN-
NETWORK SERVICES
• DESIRE GOOD PREVENTIVE
SERVICES SUCH AS COVERAGE
FOR CHECKUPS AND
IMMUNIZATIONS

7. Ask me a question…
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