This means that you must pay a stated amount first, before the insurance company begins paying benefits. If you go to a doctor or hospital who is not a member of the preferred list, the plan will cover a lessor percentage of the costs. HMOs are comprised of hospitals, doctors and allied medical personnel who have contracted to provide health care to members in return for a pre-paid monthly charge. The system is designed to eliminate any unnecessary care which would ultimately increase total health care costs. HMO's provide incentives for individuals to seek medical care.
Prescriptions are available for small copays also.
With an HMO, you do not have the option of going to a medical provider who is NOT part of the HMO network. HMO's are available on both a group and individual basis. The State of California sponsors a health care plan for individuals who have been unable to secure health care coverage through normal channels. To be eligible for this plan, an individual must have been declined for coverage in the past 12 months and meet certain residency requirements as well as waiting periods before benefits are available. This program is also sponsored by the State of California.