Live Chat Software

Health Maintenance Organization


Home > Insurance Policies > Health > HMO
An HMO is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the U.S. and acts as a liaison with health care providers on a prepaid basis.  HMOs often require members to select a primary care physician, a doctor who acts as a ‘gatekeeper’ to direct access to medical services.  Except in medical emergency situations, patients need a referral from the primary care physician in order to see a specialist or other doctor, and the gatekeeper cannot authorize that referral unless the HMO guidelines deem it necessary. With an HMO you will likely have coverage for a broader range of preventive healthcare services than you would through another type of plan, hence its name.  HMOs are typically less expensive in comparison to a PPO or EPO, but you will likely have no coverage for services rendered by out-of-network providers or for service rendered without a proper referral from your primary care physician.  

We’d love to hear from you

Contact Us

Recent News

Common ERISA Penalties by the DOL – 2017

The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.

SPD Requirements – Erisa Wrap Compliance

The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.