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HMOs in a Nutshell

HMOs, or Health Maintenance Organizations, are established networks of healthcare providers and services where a PCP actively manages patient care.

Many of your employees depend on you to provide affordable, effective healthcare insurance for themselves and their families. We know that when it comes to selecting a health insurance option for your employees, you have a lot of choices. It can be incredibly overwhelming, which is why we're here to help.

Today, we're going to talk about one of the choices you have: a Health Maintenance Organization, also commonly called an HMO.

About HMOs

An HMO is an established network of healthcare providers and services. In an HMO, each patient chooses a Primary Care Physician (PCP) who then coordinates all other care within their healthcare network, including referrals to specialists and hospitals.

HMOs are paid for through a combination of premiums, deductibles, co-insurance, and co-pays. HMO policy holders can typically expect lower monthly premiums, and they generally pay less for other out-of-pocket services. There is often a small deductible (or no deductible) that must be satisfied before healthcare coverage begins. More often than not, your employees won't have to submit any of their own claims to the insurance company, freeing up their time.

HMOs are a great option for:

  • Employees who would like to save some money and simplify their healthcare costs. As part of an established provider network, HMOs are generally able to keep costs lower and offer plans where policy holders pay a set of co-pays for specific services (as opposed to a percentage of the service they received).
  • Employees who want their PCP to help actively manage every major aspect of their health care. Patients must see PCPs to get a referral before they have access to a specialist.

One drawback of an HMO is that only emergency service is covered outside of your network. For employees who travel extensively or people who potentially split their time between two locations, an HMO may not be the best option.

Canopy Health Can Help!

We know that it's not easy to make health insurance decisions that deeply affect your employees and their families. Canopy Health is here to help you make sure you have all the information you need to make an educated and informed decision about the health insurance options your employees will have. Give us a call at 888-8-CANOPY or contact your health insurance broker for more information about HMOs.