Help Desk FAQ

Health Care/Medical


What do I need to know to get the best care for me and my family if we are covered by an HMO plan?

While reading the materials your HMO provides may not be high on your list of entertainment, an hour or two spent reviewing these documents is crucial. You need to understand what your plan covers - and what it does not cover (exclusions and limitations). Care that is specifically excluded or limited is not likely to be covered, no matter how persistent you are. For instance, many people assume that their plan allows them to have a private hospital room. Under the majority of HMO plans, hospitalized patients are required to share a room with another patient.

Review all coverage with the specific health needs of your family in mind. Look closely at the policies in these coverage 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.



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Consumer Help Desk