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HMO Health Insurance
Looking for
Group Health Insurance?
HMO Health Insurance is a Health Maintenance
Organization. It is a form of health
insurance in which members prepay a premium for
the HMO's health services. The HMO is the legal
entity that assumes responsibility for health
care services and for the cost of the insured's
care. This type of health care plan
provides a range of health care services to its
insured members. An HMO contracts with
health care providers, physicians, hospitals,
and other health professionals. This is why HMO
members are required to use participating
providers in the HMO network, which are
coordinated by a primary care physician selected
by the insured from a list of providers.
Compare to
PPO Health Insurance
HMO Terms to Familiarize Yourself with:
Co-payment. A type of cost sharing where
insured persons pay a specified fee for service
or a percent of the amount allowed as
reimbursement for a covered service. Also
referred to as "co-insurance".
Deductible. An amount the insured person
must pay before insurance payments for covered
services begin. There may also be other,
separate deductibles that apply to certain types
of services.
Exclusions. Conditions, situations, and
services not covered by the health care plan.
Health Care Provider. A doctor, hospital,
laboratory, nurse, or anyone who delivers
medical or health-related care.
Pre-existing Conditions. A condition for
which medical advice, diagnosis, care or
treatment, including use of prescription drugs,
was recommended or received from a licensed
health practitioner during a specified period of
time immediately preceding the effective date of
coverage.
Primary Care Physician
The doctor in your HMO network who coordinate
the member's medical care. Your primary
care physician provides you with routine medical
care and will refer you to a specialist when
necessary. |
