HMO 101

Posted June 18, 2010 by Katie

FCHP offers a guide, HMO 101, on our Web site to help you understand your plan. Here, we summarize the guide to give you the basics.

Health maintenance organizations (HMOs) are one of the most popular types of health insurance available today. But what is an HMO, and how does it work?

An HMO is a health plan that covers your hospital, medical and preventive care. Typically, you pay a monthly premium and copayments whenever you see your doctor, fill a prescription or go to the hospital.

In an HMO, you can only see the providers that the HMO has agreed to work with—except in emergencies, when you can see any provider. This group of providers is called the provider network. If you see a doctor who is not part of your HMO’s provider network, your services will not be covered.

Today, Fallon Community Health Plan has two HMO provider networks: FCHP Direct Care (a plan with a limited provider network) and FCHP Select Care. You know what network of doctors you can see by checking on your member ID card. If you have an FCHP HMO plan, you’ll see FCHP Direct Care or FCHP Select Care printed on your card.

Words to know

Premium – The monthly amount you pay to be a member of the health plan. Your employer may also contribute a portion of your premium.

Copayment – A set dollar amount that you pay when you visit the doctor, fill a prescription, etc. This is only a portion of what each service costs

Deductible – If you have one, is the amount you must pay out of your pocket before the plan will pay for services. More to come on deductibles in an upcoming blog post.

FCHP Direct Care is a plan with a limited provider network. This plan provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Direct Care. Please visit our Find a Doctor tool or consult the FCHP Direct Care provider directory to determine which providers are included in FCHP Direct Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

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The information written about in this blog is not intended to be medical advice. Please seek care from a medical professional when you have a health concern.