Within the complex world of medical insurance, the HMO or health maintenance organization has traditionally provided a low-cost option for providing Americans with policies carrying relatively low premiums, at the cost of a less expansive feature set on the type of policies carried by these companies.

For any business wanting to get educated on this kind of health insurance, whether it's a firm looking to send staff to school, or just looking for informative resources, the web can be a viable option:

1. For finding college or trade schools programs that will prepare staffers in all that is needed to deal with billing, claims handling and more for HMO health insurance.

2. For finding out more about the specific types of coverage that the HMO plan provides, to analyze and compare costs.

3. For getting information on general handling of this type of plan for any in-house task.

Action Steps
The best contacts and resources to help you get it done

Find school programs for HMO health insurance over the web

One resource that business leaders can find over the web is a wide array of program details on how schools will prepare staff to handle all aspects of HMO plans, including HMO quotes, communications from HMO groups and HMO providers and much more.

I recommend: Get medical assistant training for working within an HMO (as noted in the descriptive web page) at North-West College. Many other schools (like Everest College) offer HMO training as part of a medical billing regimen, along with other health care skills training options: learners get to understand the aspects of an HMO that contrast to other types of insurance policy providers.

Find more education and consulting for HMO health insurance

Another way to handle the need for education on HMO healthcare is to go to sites online that will showcase services and education for getting a business into a thorough knowledge of dealing with HMOs.

I recommend: See the article at CBS News on HMOs. The Education Resources Information Center has a program on HMO training. Agencyinfo.net has an informative article on the advantages and disadvantages of HMOs.

Use other helpful web links for critical information on HMOs

There's also a lot more on the web about HMOs: from helpful guides to materials, as well as specific HMO resource sheets dealing with this kind of plan for different perspectives. Wade through the various sites to get a good look at how HMO plans are treated and administrated.

I recommend: Find state resources like this one from New York State Insurance online for comparing HMO plans. Interested parties can find more info sources on HMO plans at Kaiser Permanente (some are in PDF format). For help with handling problems arising from disagreements in HMO coverage, this link from Consumers Union can be worth its weight in gold.

Tips & Tactics

Helpful advice for making the most of this Guide

• •  Make sure your HMOs education and training includes education on the fundamental tenets of HIPAA, a medical info privacy law governing all kinds of patient records. Following HIPAA limits liability and advances a medical career.

HMO health insurance is one of a number of options among managed healthcare plans. HMOs, also known as Health Maintenance Organizations, provide a structured healthcare plan that maintains patient treatment and care by establishing guidelines for healthcare providers.

HMOs are designed to provide full-spectrum healthcare at low cost. HMO groups contract with specific doctors and hospitals and, because of the number of patients, can negotiate for cheaper healthcare rates. There are a number of benefits in providing an HMO option for your employees:

1. If you pay for your employees' health insurance, going with an HMO will lower monthly insurance premiums.

2. You employees will only pay small co-payments to providers at time of service, rather than full payment of their bill upfront.

3. Using HMO healthcare can result in discounted overall healthcare costs.

Action Steps
The best contacts and resources to help you get it done

Compare HMO quotes and choose the best plan for your business needs

The provisions of HMO coverage varies by provider. Typical HMO quotes will include an 80/20 or 70/30 policy, meaning that the HMO pays 70% to 80% of the bill and the covered person is responsible for the remaining 20% to 30%. Additionally, the majority of HMO plans require a yearly deductible for each individual and for the entire family. Go with an HMO plan that gives your employees multiple options that will fit their physical and financial needs. Keep in mind that, if you're paying the premiums for your employees, you need to decide on a plan that your business can afford as well.

I recommend: The most widely used HMO health insurance providers are Anthem (also known as Blue Cross and Blue Shield) and Kaiser Permanente. For more options, visit Business.com for a list of other HMO providers.

Weigh the pros and cons of HMO health insurance

Before you settle on providing HMO health insurance to your employees, be sure that the benefits outweigh the disadvantages for both your staff and your business. The major benefits include healthcare costs at a discount (as mentioned above), as well as less hassle with medical bills. The cheaper premiums also mean less cost to your business. However, your employees must use HMO doctors within the established network. Additionally, employees can't receive treatment from a specialist without a referral from their primary care physician, which can be a hassle for someone with an illness such as cancer.

I recommend: Compare all of the available types of health insurance, such as Preferred Provider Organization (PPO) or Point of Service (POS) managed care plans, before making a final decision. Read Financial Web's article comparing HMO and PPO plans. Visit wiseGEEK for information on POS healthcare.

Obtain a list of providers and help employees choose a PCP for their HMO

Once you decide to go with HMO healthcare, you need to find out who the in-network providers in your area are. Additionally, HMO groups require insureds to select a primary care physician (PCP) when they establish their health insurance plan. It is important to look at the PCP's accepting new patients in your area prior to signing up for coverage so you can inform your employees about available doctors. Otherwise your employees will simply have to randomly choose a PCP from a list that the insurance company provides.

I recommend: The American Academy of Family Physicians provides detailed information on what constitutes a primary care physician. Ask friends and family for referrals, as most insurance companies now require some form of PCP for those they insure. Additionally, most HMO insurance providers, such as Anthem, have a provider directory on their website to aid you in your decision on a PCP.

Tips & Tactics

Helpful advice for making the most of this Guide

• •  The law requires managed care plan insurance companies, such as HMO and PPOs, to provide their clients with a description of the plan. This information should include thorough information on the coverage under the plan and how to appeal the insurance company's decision on that coverage.

Some business owners offer employees several choices of health insurance plans, with plans offered by health maintenance organizations (HMOs) being the least expensive. However, learning the health insurance system and properly following all rules is essential. For example, if you visit an "out of network" doctor, you could end up paying full price for the services. Understanding some of the key terms that are associated with HMOs will help users make the most of their health insurance plans.

Action Steps
The best contacts and resources to help you get it done

Health maintenance organization (HMO)

A health maintenance organization is a type of managed health system whereby users prepay for their medical services in the form of monthly premiums. Patients choose a primary care physician, who acts as a type of 'gatekeeper' for their health care. Patients who need to see a specialist must get a referral from their primary care physician. HMOs save on costs by focusing on preventative care.

I recommend: AgencyInfo.net offers a comparison of HMOs, preferred provider organizations (PPOs) and point-of-service plans.

Primary care physician

Primary care physicians are patients' first point of contact whenever they need health care. PCPs can be general practitioners, or they can specialize, usually in pediatrics or internal medicine. They work to diagnose issues early before major problems arise.

I recommend: eHealthInsurance.com offers a description of primary care physicians and what they do.

80/20 policy

HMOs often offer an 80/20 policy, which means that the insurance covers 80 percent of the cost of a procedure and the patient is responsible for the remaining 20 percent. Likewise, a 70/30 policy would mean that the insurance covers 70 percent of the cost while the patient pays for 30 percent.

I recommend: Dan Abrams Health Insurance Service discusses 80/20 policies on his website.

Medical network

HMOs work with a medical network, or a network of doctors that accepts the HMO's insurance. As long as patients see an 'in-network' doctor, the insurance plan covers the costs as the insurance agreement stipulates. If a patient sees an 'out-of-network' doctors, costs are higher to the patient.

I recommend: Cigna explains how its medical network plans work.

Co-pay

A co-pay is the amount that the patient must pay for services rendered under the HMO plan. Routine office visits, for example, generally cost a patient $10-$20.

I recommend: Investopedia offers a good description of co-pay.

Preventative care

HMOs tend to focus on preventative care as a way to lower costs. Many offer programs aimed to help patients with general wellness in an effort to prevent patients from getting sick in the first place.

I recommend: For examples of wellness programs and how they work, visit the Anthem Blue Cross Blue Shield website.