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HMO Health Insurance Plans

 

To begin with what are the advantages to having a HMO health insurance plan? The number one answer is affordable rates. They are flat monthly rates regardless if you are seen or not and zero deductibles.

 

An HMO (Health Maintenance Organization) is a type of health insurance policy given to enrolled volunteered members for the sole purpose of providing an array of health care services from a specific network of physicians and other health care specialists; for a preventative or curative approach to the volunteer member's health, in a limited geographical, financial and professional manner.

 

It is mandated for the volunteer member to select a primary care physician who will be the Captain of the volunteer member's ship. All lab work, second opinions, to have an operation or not will be decided by this primary care physician when he or she feels your health warrants these services.

 

Consider your special needs or if you have any existing health care professionals you already see and like. First ask them which HMO's they belong too. Then examine the HMO's policy. What is it the network provides and do the people you have come to rely upon belong to this network?

 

If yes, look at what the HMO excludes, how it defines emergency and the laid out mandated steps a volunteer member must adhere to in case of an emergency.

 

Ask yourself the following questions when choosing an HMO:

 

  • Will these be in accordance with your emergency plan for you or your family?

  • Will you be helped in a timely manner?

  • What facilities are used by the HMO network of healthcare specialist?

  • Are they properly equipped with modern equipment?

  • Is there a lot of run around or are you seen in a timely manner?

  • Does the facility have a good reputation for patient care?

  • Is the physician you are considering nearby and are the premiums reasonable?

 

HMO Health Insurance Models

 

Next it is important to understand how the different HMO models work.

 

  • IPA (Independent Practice Association) is when an association works as the middleman. Individual physicians sign up with the association who in turns signs on with the HMO. This is an open contract model. It allows the physician to see HMO patients and non-HMO patients in his or her existing practice.

  • Staff Model is when the physician is a salaried employee of the HMO. The physician always has his or her office in a HMO building. This is called a closed-panel model. It restricts the physician to only see HMO patients.

  • Group Model is when the HMO does not directly pay the physician but rather pays a group the physician is a member of. In turn the group pays the physician his or her agreed upon amount. This model is a closed-panel model.

  • Network Model is when the HMO contracts with a multitude of combinations of groups.

 

Tips For Choosing An HMO Health Insurance Plan

 

It is important to find out if your plan pays for and allows you to get a second opinion if the primary care physician says he does or does not think you need an operation. Many HMO's will pay for a second opinion. If not then it might be wise to have a H.S.A. Health Savings Account. It can be set up that you designate x amount of pre-taxed dollars to a health savings account to be used for health emergencies.

 

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