Traditional managed care (strong gatekeeper concept). Member must select a Primary Care Physician who oversees all medical care. For a fixed monthly premium, covers most services a member needs, but controls which providers supply these. Features include small co-pays, no claim forms and the encouragement of preventive health care. Disadvantages include restricted network of providers and need for referrals or authorization.
represent a group of health insurance policy holders in which individuals or their employers allocate a monthly fee for medical services, instead of per service pricing. The monthly HMO dues usually remain fixed, regardless of the type or level of medical service received. Professional Medical Services are performed by certified practitioners and physicians employed by, or under service contract with the Health Maintained Organization. Several types of HMO Insurance companies are available with guidelines on medical facilities and the health treatment services they offer.
HMOs are a type of managed care plan. Members of HMOs choose a primary care physician who will coordinate their routine medical care and provide treatment for a variety of conditions. The primary care physician authorizes referrals to specialists and non-emergency visits to hospitals. HMO members must use health care providers in their network, but have minimal or no deductibles and lower out-of-pocket costs than other health care plans.