- The HMO pays for all covered services as long as you use the doctors and providers in the HMO network. You may have to pay something when you get care, for example, a $10 copayment per office visit.
- Most HMOs ask you to choose a doctor or clinic to be your primary care provider, or PCP. Your PCP takes care of most of your medical needs. In many HMOs, you must get permission or a referral from your PCP in order to see other providers in the network.
- Care received from a non-network provider, other than emergency care, is not covered.
Brochure -- A plan's description of benefits, limitations, exclusions, and definitions under the FEHB Program.
Catastrophic Limit -- The maximum amount of certain covered expenses you have to pay out of your own pocket during the year.
Coinsurance -- How you and your FEHB plan split the cost of covered medical expenses. For example, a 20% coinsurance means you pay 20% of most covered charges. The plan pays 80%.
Copayment -- A fixed dollar amount you pay as your share of a service or benefit (sometimes called a copay).
Covered charges -- What the plan pays for. Youll find information about covered benefits, expenses and services in each plans brochure.
Deductible -- The amount of covered charges you must pay before the plan begins to pay.
Health Maintenance Organization (HMO) -- A health plan that provides care through a network of physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detections. Your eligibility to enroll in an HMO is determined by where you live or, in some plans, where you work. Some HMOs have agreements with providers in other service areas for non-emergency care if you travel and are away from home for extended periods.
Managed Fee-for-Service (FFS) Plan -- A traditional type of insurance that lets you use any doctor or hospital, but you usually must pay a deductible and coinsurance. These plans are called FFS because doctors and other providers are paid for each service, such as an office visit, or test. They control costs by managing patient care. They also provide access to PPOs.
Portable Document Format (PDF)
-- A method of storing electronic documents that preserves the exact look of the original. The method was developed by Adobe Systems, Inc. You must install (or have someone install for you) a free Reader program. Within the Reader program, you can navigate around the document, print all or part of the document, or search for text. This program will automatically make itself known to your Web browser so that when you click on a hyperlink that references a PDF, the Reader will start up within the browser and allow you to see the document within your browser. 
Point of Service (POS) -- A product offered by an HMO or FFS plan that gives you the choice of using a selected network of providers, like an HMO, or using non-network providers at an additional cost. If you dont use the network, you must pay substantial deductibles, coinsurance, and copayments.
Preferred Provider Organization (PPO) -- A fee-for-service product where patients use plan selected health care professionals who discount their fees to plan members. If you enroll in a plan with a PPO feature, you will pay less money out-of-pocket for medical services by visiting a PPO provider instead of a non-PPO provider.
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Questions
regarding the Federal Employees Health Benefits Program should be directed to the Office of Insurance Programs at our <Feedback Page>.
Updated 5 November 1997