Our HMOAn organization that arranges a wide spectrum of health care services which commonly include hospital care, physicians' services and many other kinds of health care services with an emphasis on preventive care. plans offer reliable coverage and access to the best doctors and hospitalsAn institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care. in Massachusetts. No matter which HMO plan you choose, it will have these features:
- You choose a primary care provider (PCP)A provider, usually a family or general practitioner, internist, or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals, and other providers as necessary. Under some benefits plans, a referral by the primary care provider is required to obtain services from other providers. Each covered family member chooses his or her own PCP from the network's providers. from your plan networkA group of health care providers under contract with a managed care company within a specific geographic area.
- Your PCP oversees your care and refersIf a PCP determines that an individual requires specialized care, the PCP may "refer" that person to an appropriate specialist. A referral is often required by a managed care plan before the plan will cover certain services. you to specialists
- Your care is covered when your doctors and hospitals are members of your plan network
Generally, our HMO plans cover these types of care:
- Inpatient and outpatient medical care
- Mental health/substance use
- Prescription drugA drug that has been approved by the Federal Food and Drug Administration as dispensable only with a licensed physician's prescription. benefits
- Preventive care covered with no out-of-pocket costs
To get the specifics of your plan, check your subscriber certificate or visit Member Central and click on the Using My Plan tab. Your member ID cardIdentification cards are provided to all participants for proper identification under their group health plan. ID card information helps providers verify patient eligibility for coverage. contains valuable information so it's important for you to card. Watch our Managed Care video to learn more about your health plan.