It’s confusing, it can be pricey, and there are several household chores you’d rather do, than deal with it… It’s your health benefits. But don’t worry, you can do this. Welcome to your health benefits 101.
What is an HMO? It is one common type of health insurance plan.
HMO stands for Health Maintenance Organization. This type of plan not only pays for major health events in your life, but also focuses on health maintenance, wellness, and disease prevention.
An HMO may require you to live or work in a specific geographic area to be eligible for coverage. The HMO might be right for you if you live in the HMO plan’s service area. In some cases, an HMO is the most affordable option.
HMOs utilize networks. The networks consist of select hospital systems and the doctors and clinics associated with those systems.
With an HMO, you cannot seek care outside of the network, except in the case of a true emergency.
It is important to understand which health care providers or networks are “in-network” for your HMO plan. This information is available in the resources provided to you by your insurance company.
Unless it is a serious emergency if you receive health care from an out-of-network provider you would have to pay the entire bill yourself.
Other Types of Plans
When it is time to enroll in benefits plans, HMO plans, PPO plans, or POS plans may be offered as options to you. These are simply different types of health coverage insurance plans. Each type of plan may vary in the costs associated with it, coverage regions, and network providers.
It is up to each individual to elect coverage that is best for his or her situation. When determining which health plan is right for you, there are a few relevant factors you may wish to take into account, including:
- geographic location
- personal budget
- dependent family members
- type of health care services needed
- frequency of services needed
Still, choosing a health plan can be tricky. A bit of prep and analysis of your current circumstances will lead you down the right path. The more you understand general health benefits concepts, the better equipped you will be to read over the information from different insurance providers and to make an educated choice of a health plan that best suits you.
Even if your employer provides just one health plan coverage option, reading plan documents carefully will help you greatly to know how you can use that plan wisely and control your out-of-pocket costs.
But wait, there’s more. This is a general description of an HMO, but that isn’t all of it. Check your Summary Plan Description (SPD) from your health insurance company. It contains what you need to know about the specific rules of your plan.
If you want to know rules about any of our Employee Benefits Corporation plans, please check the specific Plan's Summary Plan Description (SPD) by logging in at www.ebcflex.com to access it. There you will also find other helpful information that explains the specific rules for your BESTflexSM Plan health care flexible spending account, EBC HRASM, or SimplyHSA; the benefits that give you ways to save pre-tax money on your healthcare expenses.