Traditional managed care (strong gatekeeper concept). Member must select a Primary Care Physician who oversees all medical care. For a fixed monthly premium, covers most services a member needs, but controls which providers supply these. Features include small co-pays, no claim forms and the encouragement of preventive health care. Disadvantages include restricted network of providers and need for referrals or authorization.
represent a group of health insurance policy holders in which individuals or their employers allocate a monthly fee for medical services, instead of per service pricing. The monthly HMO dues usually remain fixed, regardless of the type or level of medical service received. Professional Medical Services are performed by certified practitioners and physicians employed by, or under service contract with the Health Maintained Organization. Several types of HMO Insurance companies are available with guidelines on medical facilities and the health treatment services they offer.
HMOs are a type of managed care plan. Members of HMOs choose a primary care physician who will coordinate their routine medical care and provide treatment for a variety of conditions. The primary care physician authorizes referrals to specialists and non-emergency visits to hospitals. HMO members must use health care providers in their network, but have minimal or no deductibles and lower out-of-pocket costs than other health care plans.
"HMO's usually have excellent benefits (at reasonable premiums). Most of an individual's health care is directed through a Primary Care Physician (PCP). Most HMO's do not require a referral to OBGYN's, Dermatologists, or Mental Health Providers. Services in an HMO are usually provided by physicians who are employed by, or under contract with, the HMO. Depending on the type of HMO, services may be provided in a central facility, or in a physician's own office. No benefits are available for out-of-network charges. Typically, you will recieve more benefits for your premium dollars in an HMO plan than other types of plans, due to how the fees for services are paid."
Health Maintenance Organizations represent "pre-paid" or "capitated" insurance plans in which individuals or their employers pay a fixed monthly fee for services, instead of a separate charge for each visit or service. The monthly fees remain the same, regardless of types or levels of services provided, Services are provided by physicians who are employed by, or under contract with, the HMO. HMOs vary in design. Depending on the type of the HMO, services may be provided in a central facility, or in a physician's own office (as with IPAs.)
HMOs are organized systems for providing health care within a geographic area. Each HMO plan offers a set of basic and supplemental preventative and treatment services. Members typically select primary care physicians who are responsible for making referrals to specialists when needed. HMOs offer no "out of network" benefits and have low out-of-pocket (co-pay) expenses.
Health Maintenance Organizations represent "pre-paid" or "capitated" health care plans in which individuals pay small fees or copayments for specified health care services over and above the monthly premiums paid to be a member of the HMO. Services are provided by physicians and allied health care personnel who are employed by, or under contract with the HMO. HMOs vary in design. Depending on the type of HMO, services may be provided in a central facility, or in an individual physicians office. HMO's are available on both an individual and employer group basis.
HMOs are a form of prepaid medical care. Insureds pay monthly premiums and receive medical care at no additional charges except for nominal amounts per visit to physicians.