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Health Maintenance Organizations (HMO)


   

Health maintenance organizations (HMOs) provide health care for their members through a network of hospitals and physicians. Comprehensive benefits typically include preventive care, such as physical examinations, well baby care and immunizations, and stop-smoking and weight control programs.

The main characteristics of HMOs are:

  • The choice of primary care providers is limited to one physician within a network; however, there is frequently a wide choice for the primary care physician.

  • There is no coverage outside the HMO network of hospitals and physicians.

  • Costs are lower, due to limited choice. Physicians are encouraged to keep patients healthy; accordingly, they often are paid on a per capita basis, regardless of how much care the patient needs.

The employer prepays HMO premiums on a fixed, per employee basis. Employees do not have to apply for reimbursement of charges, but they may have small copayments for medical services.

 

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