Using Your Medical Plan — HMO
Health Maintenance Organizations (HMOs)
As an alternative to the Traditional PPO or Value PPO, you may elect medical coverage with an HMO if you live in California or a New England state (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island or Connecticut).
Generally, you will need to select a PCP to provide or coordinate all your care. There is no deductible. Note that care obtained outside the HMO network generally is covered only in emergencies, as defined by the HMO.
| | Copayment |
|---|---|
| PCP visit | $25* |
| Specialist visit | $50 ($45 for HMO Blue New England)* |
| Emergency room visit | $150 |
| Inpatient hospitalization | $500 |
* Eligible preventive care, including well-woman care, is covered at 100%.
Prescription Drug Coverage
The HMOs cover short-term prescriptions (up to a 30-day supply) purchased at a network retail pharmacy and, in most cases, 90-day supplies through a mail-order service. Copayments vary by plan.