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Traditional HMOs

Depending on where you live, in many parts of the State, you may also select a Traditional HMO. With a Traditional HMO:

  • You must use network providers to receive benefits; no benefits are paid when you use non-network providers.
  • Set dollar copayments keep your costs more predictable.

Plan Highlights

 

Traditional HMOs

Covers care received

network only

No annual deductible

  • Individual
  • Family

$0
$0

What you pay for care received

  • Doctor office visits
  • Hospital stay
  • Prescription drug
    • generic
    • preferred brand
    • non-preferred brand

$15/visit for PCP; $25/visit for specialists

$250/visit

$10/retail; $20/mail order
$25/retail; $50/mail order
$40/retail; $80/mail order

Annual out-of-pocket maximum

  • Individual
  • Family

$1,500
$3,000

Preventive care: routine physical exams, health screenings and immunizations at specified intervals

As covered by the HMO you select