WHAT IS AN HMO? SHBP Health Maintenance Organization

SHBP HMO A HMO provides major medical, treatment of illness including pharmacy coverage only when using in-network providers (except in cases of emergencies). This Plan features certain services that are subject to a deductible and co-insurance which count toward your out-of-pocket maximum. However, co- payments do not count toward your deductible or out-of-pocket maximum. Although you are not required to obtain a referral to a specialist (SPC), you are encouraged to select a primary care physician (PCP) to help coordinate your care.

HMO TIER Deductible Wellness and Standard Out-of-pocket Max Wellness and Standard You$1000$3000 You + Spouse$1500$4500 You + Child(ren)$1500$4500 You+ Family$2000$6000 Specialist office visit co-pay is $55 and PCP $45, after the co-pay, the plan pays 100%. ER Care, $150 co-pay. See Summary in Health Guide for full hospital in/outpatient services schedule.