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What is an HMO?
HMO stands for Health Maintenance Organization, a managed care plan where
you have the ability to choose your primary care physician (PCP) from
a list of network providers. Your PCP is responsible for management of
all aspects relating to your health care. If you require care from any
network provider other than your PCP, you may need a referral from your
PCP to see that provider. Check with your plan to see if your PCP is also
the "gatekeeper" for access to other network providers. You
must obtain care from a network provider in order to have your claim paid
through the HMO. Treatment received outside the network is generally not
covered, or covered at a reduced level.
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