This plan provides similar benefits to our fully-funded HMO plan. It is, however, funded by the employer. HomeTown's administrative fees and reinsurance costs are a fixed monthly fee, and capitation of Primary Care Physicians can be maintained. Claims are paid from the employer's funds as they are incurred. Use of HomeTown's aggressive medical management will result in significant reductions in employers' claim costs.
Employees benefit from ease of use and increased coverage.
Employers create the benefit package for their employees, choosing deductibles, coinsurance, pre-existing condition limitations and other options. HomeTown continues its aggressive HMO-style management of the physician network, referral system, hospital and pharmacy utilization and all the other aspects of healthcare delivery. When care is delivered in-network, Primary Care Physicians oversee care and refer to HomeTown network specialists. Employees can receive unmanaged care, or care out of the network, but benefits will be paid at lower levels. HomeTown reduces costs by establishing cost-saving contracts with physicians and hospitals and determining appropriate care through utilization review.