HMO stands for Health Maintenance Organization. HMO is a company that offers health plans, that provides medical care from an approved network of doctors, hospitals, and pharmacies. The patient needs to pay a preset minimum fee per visit. The HMO fees are usually lower than PPO (Preferred Provider Organizations).

The advantages of HMO:

  • No or very low deductibles
  • Comprehensive benefits
  • Preventive care is often good

The disadvantages of HMO:

  • HMO plan includes only a particular chain of hospitals and doctors
  • The patient must see doctors within the network
  • The patient must get permission from the primary physician to see a specialist, or the HMO may not pay for the services
  • HMO’s often refuse to pay for the emergency visits, if they don’t consider it as a true emergency

Important points to note regarding HMO plans

Once you’ve signed and received your HMO plan, be sure to read your policy thoroughly and carefully. You should know answers to questions like:

  1. Which doctors, hospitals you may see?
  2. What procedures are covered and what aren’t?How are emergency visits handled? And what procedure you must follow to get the full coverage?
  3. How are emergency visits handled? And what procedure you must follow to get the full coverage?
  4. What kind of cases come under emergencies? (As they may deny coverage, if they don’t consider your problem as an emergency.)
  5. What is the co-payment cost? (i.e. How much you will have to pay per visit?)
  6. Find out the procedure for claims, if any.