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HMO Plans

Health Maintenance Organization

Health Maintenance Organizations (HMO) are health insurance companies offering health treatment within their network of doctors and medical centers. Insurance from Health Maintenance Organizations are generally inexpensive but includes certain limits. The HMOs do not require any coinsurance and usually includes a deductible.

Features of a Health Maintenance Organization

  • Insurance plans under HMOs provide coverage only for the general physicians, medical clinics and health centers within their network of services.
  • If you feel the need to visit some other specialist you have to seek reference from the general physician within the network of the HMO. The HMO will pay for your health expenses for the specialist only if your general physician refers you to him.
  • Insurance plans of Health Maintenance Organizations are by and large of a lower value than any other Preferred Provider Organization (PPO) plans, so it sets certain limitations for the purchaser.
  • Insurance buyers from Health Maintenance Organizations are only required to pay a fixed premium once a month for all their medical requisites. HMO plans comprises of regular health check-ups, medicines, treatments, surgical expenses etc.
  • Health Maintenance Organizations pay only for the hospitals and treatments within their network of services. This network extent may differ from one organization to the other.
  • To be on the safe side you should always verify the terms and conditions of a HMO before purchasing a health insurance policy. This will help you to have a better idea of the services that it can provide. A brief survey on different HMOs may also assist you in finding the right organization that will aptly carter to your health requirements within your budget. For free quotes on HMO plans you can visit www.medical-insurance-quotes.us

Merits of Health Maintenance Organization Plan over Other Insurance Plans

Health Maintenance Organizations hold a special position in providing low-cost medical insurance plans to individuals and families. HMOs ensure a number of health care facilities within their network and within the reach of the policy holder. Apart from these the other benefits of HMOs are listed below.

  • Health Maintenance Organization persuades the policy holder to go for medical check-ups early to avoid serious health complications in future. It helps the purchaser to stay aware of all health and fitness programs and even guides accordingly on maintaining a proper health.
  • A HMO plan generally does not necessitate a co-insurance and charges the premium only with a small amount of co-payment.
  • The co-payments are charged on the basis of health treatment and there are no deductible amounts.
  • The amount of the monthly payment does not depend on the medical needs of the policy-holder.
  • One striking merit of an HMO policy is that it does not demand lifetime payment. A policy holder can enjoy the benefits of the insurance policy as long as the policy is valid.
  • HMO billing format is simple and comprehensive than payment formats of other medical insurance policies.

Demerits of a Health Maintenance Organization Plan

The Health Maintenance Organization policy has been the axis of ridicule due to some of its restrictions and constraints. Take a look at the drawbacks of the HMO plan.

  • Primary Care Physician is the only dependence to all your health problems. A HMO allows you to visit a specialist only after the referral from the general physician within its network. On the other way this limitation helps to lower the cost of a HMO policy.
  • Health Maintenance Organizations only provide coverage for treatments and medications within the network. If you want to consult any specialist out of the network of your HMO then you have to bear the entire cost of medical treatment by yourself.
  • HMO plans are restricted by several conditions. Any medical urgency will not be covered if it does not fulfill the terms pre-set by the organization.
  • HMO plans often include quotas for patient. This is another limitation in the HMO policy. A HMO doctor is permitted to examine only a certain number of patients on a given day. This might affect you in getting your required attention from the physician.
  • There are physicians who receive a particular share of the HMO policy despite the number of patients he attends. This also helps the physician to choose only a limited number of patients for a day.
  • Health Maintenance Organizations often put conditions before providing coverage to your expenditure on medical check-ups. You may be asked to get your diagnostic reports endorsed to include the expenditure within the policy. This kind of limitations might delay a medical treatment.

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