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This is generally the least expensive group health option, and also the least flexible. In exchange for a monthly premium, you are entitled to doctor visits, preventive care, and medical treatment, all for an additional co-pay of $5 to $10 for each appointment. You cannot visit a doctor who's outside the HMO network. Requiring you to visit only doctors who are contracted to provide services allows an HMO to keep its costs down.
An HMO covers prescription drugs. As the employer, you decide what percentage of each prescription will be covered by the HMO, and what the employee pays out-of-pocket. This can range from a single-digit co-pay of $5 for some drugs, to a co-payment covering almost the entire cost of the drug.
An HMO requires patients to select a primary care physician, a gatekeeper who takes care of your routine medical needs, such as checkups and basic prescriptions. Your primary care doctor also can refer you to a specialist, who is also within the HMO network. The only time that an HMO will pay for your medical care without a referral is for emergency-room treatment. By law, an HMO cannot require referrals for emergency care.
posted by renaa
@ 6:30 PM
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