Healthcare Acronyms

Health Maintenance Organization

The most restrictive of the three managed health care plans. Members must receive medical care by doctors within their provider networks. By staying in-network, members receive the highest amounts of insurance benefits that result in no deductibles and little to no co-payments. HMO plans require members to choose Primary Care Physicians (PCPs) from their provider networks. PCPs are in charge of their patients' medical decisions. They can refer them to other doctors and specialists who operate out-of-network, and members will receive insurance coverage. However, if they decide to go out of network without referrals from their PCPs, members will be solely responsible for all incurred medical costs. See also EPO, POS, and PPO.