Members who elect an HMO plan will need to select a primary care physician (PCP) from a network of participating providers. A PCP can be a family practice, general practice, internal medicine, pediatric or an OB/GYN physician. The PCP will direct all healthcare services and will make referrals for specialists and hospitalizations. When care and services are coordinated through the PCP, only a copayment will apply. There are no annual plan deductibles for medical services obtained through an HMO.
The minimum level of HMO coverage provided by all plans is described on this benefit chart. Please note that some HMOs provide additional coverage, over and above the minimum requirements. A $75 prescription deductible applies to each plan participant.
If a member is enrolled in an HMO and their PCP leaves the HMO plan’s network, the member has three options (must be elected within 60 days of the event):
- Choose another PCP within that plan;
- Change to a different managed care plan; or
- Enroll in the Quality Care Health Plan.