Here's everything you need to know about HMO Insurance plans

Wouldn’t it be wonderful to have an insurance plan that requires the least amount of paperwork? Well, all of that is possible if you want with HMO insurance plans.

So what is an HMO insurance plan? HMO insurance, also known as “Health Maintenance Organization” insurance plans is a type of ‘managed care’ health insurance that helps its members place their health on top priority. Having an HMO plan ensures that you do not have to shell out a lot of money in treating an illness, but rather saves more by preventing the illness from growing.

Choosing HMOs can be a confusing choice especially if you have never opted for one before. Hence, below, is mentioned everything that you need to know about an HMO plan before you can decide on whether to opt for one. Let us see what an HMO insurance plan really is.

How does it work?

Being a member of an HMO plan requires you to first choose a Primary Care Physician (PCP) from an approved list of providers. Your PCP will ensure that all your basic healthcare requirements are taken care of. If you require specialist recommendations, your PCP will be responsible for referring you to specialists who are within your HMO’s network so that you stay covered under your plan. As a member of an HMO insurance plan, if you use a doctor or health facility outside the HMO’s network, you may have to pay for the full cost of the services that you get.

Some exceptions when you are allowed to use a specialist out of the HMO network are-

- Unavoidable emergencies

- If the HMO network of specialty services does not have the care that you require.

- In case you are already under a special treatment before you become an HMO member and the specialist is not within the network. This, however, depends on the HMOs decision on a case-to-case basis.

Is the plan suitable for you?

It’s true that HMO insurance plans give you coverage for a wider range of preventative healthcare services. However, if you are alone with no dependants then choosing an HMO insurance plan could be an expensive choice. However, if the circumstances are the opposite this may be the best plan for you, taking into account its low premium and no deductible. Nevertheless, always be careful to read the fine print before you sign off the deal since HMO health insurance plans come with certain stipulations that result in low premiums.

Is it expensive?

Irrespective of the stringency that HMO plans apply when it comes to choosing your health care provider, they are one of the affordable types of insurance plans available in the market. As mentioned above, premiums for HMO insurance plans are more affordable as compared to other comprehensive healthcare insurance. Furthermore, there are no deductibles, which ensures you that there will no out-of-pocket expenses from your end prior to any insurance claims.

HMO insurance plans can be a boon for those who are on the lookout of budget-friendly healthcare facilities. But, if you are someone who is looking for flexibility, then it’s not. Like any other health insurance plan, it is always best to weigh out your options with HMOs too so that you make a decision that is right for you all along.


ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address –
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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