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Popular HMO Terms
HMOs, or health maintenance organizations, come in many forms. There are specialized terms associated with HMO coverage and insurance, and it is important to know these terms so that you can make the most of the medical and dental services involved. Following are a few popular terms that your insurance company or HMO may use.
Copayment – A copayment is a set fee that is paid when certain medical services are rendered. Some HMOs may only require copayment for special visits or procedures.
Deductible – A deductible is what you pay for medical and dental services before your health insurance provider or HMO begins coverage. This is usually based on a yearly amount.
Dependent – A dependent is a person who relies on someone else for support. This is typically a child but can include a husband or wife.
Primary care provider – A primary care provider is your main physician under a health maintenance organization. It is your primary care provider who determines whether or not a specialist’s assistance is required. This decision is typically based on specific guidelines set by your HMO.
Open-ended HMO – An open-ended HMO gives its participants the option of visiting a doctor who is not in the HMO’s preselected network. The HMO will typically make the visit or procedure more affordable or, in some cases, free.
Reasonable and customary fees – Reasonable and customary fees are what medical and dental procedures typically cost in a certain area. Most HMOs and insurance companies will use these fees as a standard for what their plans will cover.
Stop-loss – Stop-loss occurs when an insured individual has reach the maximum amount of out-of-pocket expenses and deductible fees that an insurance policy or HMO requires. After stop-loss all medical expenses are the responsibility of the insurance company or HMO.
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Health maintenance organizations provide health care coverage to people all over. Also known as an HMO, these managed care organizations work through doctors' offices, hospitals, exclusive medical clinics, and specialty physicians all over. This is why it pays to have an insurance plan in place when you need medical assistance. The standard coverage or premium you pay each month will help you manage the expenses for health care treatments. Often an HMO or insurance plan will cover a good percentage of your medical expenses.
There are a number of health maintenance organizations in existence. Depending on the level of coverage you prefer, the HMO to provide for you, your kids, and your family, different options are available. Typically there are monthly premiums or payments that each member or customer pays to the health maintenance organization. There are varieties of insurance plans that can fit any budget. These organizations do take into consideration certain things when you sign up for personal or family coverage. Some of these things may be past health problems, how often you exercise or your fitness level, your age, and what ailments are in your family. Fortunately, health care insurance plans can be chosen to cater to your lifestyle and budget.
If you are interested in learning more about health maintenance organizations, then you should use the web to your advantage. Online you can easily learn a great deal about possible insurance coverage plans, nationwide providers, as well as hospitals and local doctors that apply to these plans.