Released: January 29, 2019

Help Desk FAQ

What do I need to know when using an HMO plan?

While reading health plan materials may not be high on your list of things to do, an hour or two spent reviewing these documents is crucial when choosing or using an HMO. You need to understand what the plan covers and what it does not cover (exclusions and limitations). Review all coverage with the specific health needs of your family in mind. Look closely at the coverage provided in these areas: chronic conditions (such as asthma or diabetes), emergency care, prescription drugs, mental health, reproductive health and maternity benefits, coverage while traveling and referrals to specialists.

As an HMO member, you are less likely to have problems if you know what your rights and responsibilities are under the plan. If you don't understand something in your plan description, call your HMO member services department and ask for an explanation. Most plans have a toll-free number, which can be found on your membership card. Before obtaining care, confirm with the HMO that all the provider(s) you would be using are covered by the plan (for example, not just the ER facility, but also any attending specialist or surgeon).