Health Maintenance Organization (HMO)

Health Maintenance Organization plans are well known to focus on prevention and wellness. When you opt for a HMO plan, you require to take most of your care from a primary care physician, who is well aware of your health picture. In case of these plans, you take most of your medical care from network providers, except in emergency. HMO plans do not have any deductible, but instead have flat co-payments.

When you opt for HMO plan, you have select a primary care physician, who will be responsible for your care. He may be your family doctor, pediatrician, gynecologists or general physician. If you become ill, you primary doctor will look into your treatment unless it is emergency. He/She will give you a referral if he/she needs a specialist. It is only with this referral, your HMO will provide you due coverage.

In case of an admission to a hospital, you need to have pre-certification from your insurer, unless it is an emergency. If it is emergency, one of your family member, you doctor or your hospital need to contact your insurer within certain time period, so that the medical expenses for the same could be covered.