In a Health Maintenance Organization (HMO), the health insurance company provides you a range of medical benefits. It agrees to pay for your medical expenses and has certain guidelines for the same. The rules of these plans and the variety of medical services provided by each company are different. Additionally they also vary with different types of plans. It is therefore essential that you learn your policy carefully and decide accordingly.
Network hospitals
When you enroll in a HMO, you are required to make a fixed monthly payment in the form of premium and follow their set of guidelines. HMOs generally have a network of doctors and hospitals and list of these will be made available to you at the time of enrollment. It is important that you enquire about this and get to know about it well in advance. You need to see a physician and then with the referral opt for further specialty medical services.
In case of medical needs you just have to present an identity card which carries your details and details of your insurance plan at the doctor’s clinic or hospital. You may have to meet the copayment for certain medical services depending on your plan. However, it still works out to be cost effective and predictable as compared to the entire medical expenses.
It is necessary that you opt for medical service only from the network doctors and hospitals. In case you decide to opt for service from another medical center, (one which is not on the insurance company list), you expenses will not be covered.
