It’s personal care made simple. Easier on the wallet, HMO plans are designed to save you money while providing you more support along the way. HMO plans offer lower monthly premiums, copays and out-of-pocket costs. You’ll pay a lower, predetermined copay for most doctor visits, prescriptions, hospital stays, urgent care visits and emergency room visits.
HMO’s, or guided care health plans, are great for members who want a doctor dedicated to coordinating their care.
Here’s how it works.
- You choose an in-network primary care provider (PCP) from Health Plan of Nevada’s HMO provider directory. PCPs are the leaders of your health care team. You and your PCP will work together.
- You’ll see your PCP for routine care, yearly checkups, and other general health concerns. And, if necessary, he/she will communicate with other doctors, like specialists, to discuss additional testing or treatment. With an HMO plan, your PCP helps coordinate specialty care through a referral.
- Preventive care available at no cost. Your plan covers preventive care screenings at no cost when you see a network provider.
- You get a team of health care professionals. With our guided care model, we have a team of health care professionals working together to keep you healthy. PCPs, along with other providers, will coordinate your care.
What is a Group POS plan?
It’s personal care combined with freedom of choice. With a POS plan, you can choose how you want to use your health plan based on three benefit tiers. Combining the best features of an HMO and PPO, POS plans give you choice.
Here’s how it works.
- You pick the benefit tier you want each time you access care. For example, if you see a specialist once or twice a year, you may decide to access that specialist directly for a higher cost share and not worry about getting a referral from your PCP.
- To take advantage of Tier I HMO benefits, you must choose a Health Plan of Nevada contracted primary care provider (PCP). You’ll see your PCP for routine care, yearly checkups, and other general health concerns. In return, your PCP will keep a record of your health history to make informed decisions about your care.
- With Tier I, your PCP helps coordinate specialty care through a referral. You’ll visit your PCP for an initial exam. If you need a more thorough diagnosis, your PCP will refer you to a specialist. This option provides the most coverage for the least out-of-pocket cost.
- With Tier II, you can bypass your PCP to see a specialist or a doctor in network, but you will share more of the cost. This may include copayments or coinsurance for office visits, coinsurance for other covered services and a deductible. This tier also has a larger provider network.
- With Tier III Out-of-Network, you can visit any licensed health care provider or hospital. However, you are responsible for paying all costs for care at the time of service, filing claim forms for reimbursement, meeting a deductible and sharing higher coinsurance.