Health Maintenance Organizations

HMOs (Health Maintenance Organizations) are prepaid health insurance plan. You have to pay a monthly premium to become member of HMO. HMO provides you and your family with following facilities associated with medical care.

• Expenses on visit to doctor
• Expenses made on emergency care
• Expenses incurred on hospital admissions
• Expenses made on surgeries
• Expenses incurred on different types of therapies
• Expenses on X-rays and other laboratory tests

HMO provides these facilities to you either through their own medical practitioners or through empanelled hospitals and medical professionals. Though you have limited choice for obtaining treatment from HMO clinics or empanelled clinics, you are permitted to avail medical treatments from other hospitals/doctors in case of emergency.

The costs you pay through HMO services is comparatively lower when compared to cost you pay in fee-for-service insurance plan. Some HMOs have co-payment system in which you may have to pay certain amount of fees for visit to doctor or treatment at emergency room. However, these are nominal and comparatively cheaper.

As you pay a fixed premium to the HMO, it is the responsibility of the HMO to ensure that you get required health care to avoid getting the problem serious at later stage – which obviously will be more expensive. To assure you maximum health care HMOs provides you with preventive measures like immunizations, office visits, physical examinations, baby check-up programs and mammograms facilities. Different HMOs offer different types of plans. You should choose a right plan to obtain maximum services and benefits.

Another advantage of participating in an HMO insurance plan is that you need not to produce claim forms for your hospital admissions and visits to doctors. Usually, HMO members are provided with a card – just like any other card you use such as ATM Card or Credit card – which you have to produce at the clinic for obtaining treatment. The only disadvantage of HMO plan is that you may have to wait for longer periods at clinic as the number of patients availing this facility is considerably greater.

Some HMOs, as a part of prepaid practice, deploy salaried doctors which have offices either in an HMO building or in your apartment premises. In other cases, HMO contracts with group of doctors to provide medical care to its members. These groups of doctors are also referred to as Individual Practice Associations. These IPA comprises of private medical practitioners who have contract with HMO to provide medical care to the members of HMO. It is advisable to choose a doctor from list of empanelled doctor’s list which has IPA network. Your present family physician may also be a participant of the IPA. So, when you think of participating in an HMO plan confirm from your doctor whether he is participant of the plan. Responsibility of taking your medical care, referring you to a specialist and specialized treatment centers is lies with

your HMO appointed doctor. Usually, you can not obtain specialized treatments without referral from your primary health care provider. However, emergencies are an exception for this clause.