ANSWERS: 1
  • A health maintenance organization (HMO) insurance policy is a policy that is often less expensive and usually restricts you to a specific team of health care professionals that accepts this type of insurance.

    Insight

    With this type of insurance policy, you must select a doctor to serve as your primary care physician who will then coordinate all your health care needs, including referrals to specialists when deemed necessary. Visits to an obstetrician/gynecologist or to the emergency room are the only exceptions for not having to visit your primary care physician to get an approval to go elsewhere.

    Benefits

    Even though HMOs offer a basic set of health care services for a prepaid, fixed fee, these services include physician, hospital and other professional health care services that limits patients' out-of-pocket expenses. Usually the cost of this insurance is much less than other plans.

    History

    In 1973, President Richard Nixon signed off on the HMO Act that requires employers with 25 or more employees to offer federally certified HMO options.

    Types

    According to allinsuranceinfo.org, there are different types of HMOs. The first being the network model that is based on contracts with more than one physician multi-specialty groups, individual practice groups and individual physicians who provide a variety of medical services to HMO members. The staff model is a type of HMO in which medical professionals and doctors are hired as HMO employees, are given a salary and only see HMO members in the clinics and other facilities owned by the HMO. These contracted doctors are limited to provide medical services to only HMO patients. Individual practice association (IPA) is another type of open-panel HMO, in which independent practicing physicians have an opportunity to maintain their own offices and provide their services to both HMO and non-HMO patients. This group of physicians receives a fixed amount per patient. Lastly, the mixed model HMO combines features of several HMO forms within one plan and provides comprehensive medical care to enrollees on the basis of a prepaid contract.

    Warning

    Remember to read your policy and check which services your HMO covers because procedures that are deemed cosmetic or experimental may not be covered. Only use physicians and hospitals that are within your plan's network or you may be responsible for the costs you incur from those visits.

    Source:

    USASearch.gov

    Department of Insurance: Financial Institutions and Professional Regulations

    All Insurance Info: Health Maintenance Organizations

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