What is an HMO?
HMO, or Health Maintenance Organization, is a gated network health insurance policy that requires the member to choose a Primary Care Physician at the time of enrollment. HMO plans typically offer lower premiums for healthcare as the insurer is able to more readily predict member costs throughout the year. HMO issuers are able to do this by requiring members to obtain a referral in order to see a specialist. HMO plans require all member care to be obtained in-network and oftentimes, networks are localized into specific facilities in which members are required to obtain all care. Oftentimes, the networks are localized and the network offers in-network coverage only with an exception for urgent or emergency medical needs.
Why offer an HMO?
HMOs offer lower premium prices in exchange for a smaller network. HMOs also typically provide better coverage of networks in the state of California.
Where are HMOs available and who is eligible?
HMO coverage through Aetna on Justworks will only be available to companies headquartered in California and employees living in California. HMO coverage is also available if your company is located outside of California but has remote employees living in California.
The HMO is offered through Aetna in two different coverage networks: HMO and Aetna Value Network.
HMO coverage through Kaiser Permanente on Justworks will only be available to companies headquartered in Southern California, Northern California, Georgia, Northwest (Oregon), and MAS (MA, VA, DC).
You can learn more about Kaiser Permanente in Hawaii here.
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.