Health Maintenance Organization A Health Maintenance Organization (HMO) plan offers predictible out-of-pocket costs for members, as well as the opportunity to work one-on-one with a personal doctor. Covered members choose a primary care physician (PCP) who tends to their health needs. When necessary, the PCP refers the member to other in-network providers.

How HMOs Work

Each family member can choose his or her own primary care physician.

• Member builds a relationship with the PCP and seeks PCP’s guidance when specialists are needed
  
  
• Referrals to specialists may be required
  
  
• For most services, the plan pays 100 percent – other than copayments – as long as the provider is in the network
  
  
• Coverage for services from out-of-network providers only in emergency situations or when Humana has given prior authorization