What is an HMO?
HMO, or Health Maintenance Organization, is a gated network health insurance policy which 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 often times, networks are localized into specific facilities in which members are required to obtain all care. Often times, 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?
HMO coverage through Justworks will only be available for companies and employees in California. It is also available if a company is located outside of California but has employees living in California.
The HMO is offered through Aetna in two different coverage networks: HMO and Aetna Value Network.
Companies with their primary address in California will have access to offer HMO plans.
Companies with employees in California will also be able to offer HMO plans.
Employees living in California will be able to elect HMO coverage if offered by their employer.
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.