Health Maintenance Organizations (HMOs)
An HMO is a healthcare group that provides services and supplies exclusively through their HMO network of doctors, hospitals, and other healthcare facilities.
When you enroll in an HMO plan, you will be asked to select a Primary Care Physician (PCP) from within the HMO network to coordinate all of your healthcare needs. You must list the physician’s IPA site number on your benefits enrollment form. Your chosen PCP must authorize and refer all services rendered under the plan you have chosen. If you choose to receive care that has not been authorized by your PCP, no benefits will be payable for those services, except in some emergency medical situations. HMOs do not have a lifetime maximum medical coverage limit and services are paid according to the contract.
As an HMO member you have the right to request a change to another PCP at any time during the benefit plan year. Whenever you wish to change your PCP, you are required to phone the Customer Service number for your HMO plan and speak directly to an HMO Representative regarding the change. The HMO Representative will advise and confirm with you if the doctor you switch to is accepting new patients and will immediately provide you with an effective date for the PCP change. If you are notified by your HMO that your physician will no longer participate in the HMO plan or group, you will need to call the HMO’s Customer Service number and select another PCP.
Loyola offers HMO Illinois. HMO IL has no deductibles or coinsurance levels. There are some services that have co-payments, such as doctor’s office visits, prescription drugs and emergency room visits. (Please see the following grid for comparison of the HMO plan.)
Please note that HMO Illinois has a different network of physicians. When trying to select a PCP, you should visit the respective websites or work directly with the Customer Service Department.
Enrolling/Change in Coverage
Employees have 30 days from the date of a qualifying life event or 30 days from their eligibility date to enroll or make changes to their health, dental, and reimbursement accounts.