Health Maintenance Organization (HMO):
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally will not cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. Health Maintenance Organization provide medical treatment on a pre-paid basis which results in lower out of pocket costs. A primary care doctor (PCP) must be selected from within the HMO network who will be the first contact for all medical care needs. The PCP must be consulted before issuing a referral to see a Specialist. There is usually no lifetime maximum for an HMO plans. HMO plans do not reimburse for out-of-network charges, or out of pocket expenses except for emergencies occurring outside of the HMO’s network area.