Health Maintenance Organization (HMO) Plan

A type of coverage that provides comprehensive health services to members in return for a monthly premium and copayment. In an HMO plan, members may choose a primary care physician (PCP) who coordinates each assigned member’s care. The PCP refers patients to specialists and provider services as needed. Although many HMOs require their members go to the doctors and other providers in the HMO provider network, some HMO plans offer the option to go out-of-network (for example in a POS plan). HMO plans often require members receive a referral from their PCP before seeing a specialist. (See primary care physician and point of service plan.)

See Also: Health Maintenance Organization (HMO); Home Health Care; Hospital Care;

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