What type of plan usually will not pay for services received outside its network?

A Health Maintenance Organization (HMO) plan typically will not cover services received outside its network. This type of plan is designed to provide managed care services and emphasizes a coordinated approach to patient care. Members are required to select a primary care physician (PCP) who will manage their healthcare needs and provide referrals to specialists within the network.

If an HMO member seeks care from a provider or facility that is not part of the network, they usually will not receive any benefits, which means they will need to pay for the services out-of-pocket unless it is an emergency situation. This structure helps to maintain lower overall costs for both the insurer and the insured by encouraging the use of in-network providers, which have pre-negotiated rates and streamlined procedures for authorizations and referrals.

Other types of plans, such as Preferred Provider Organizations (PPO) or Exclusive Provider Organizations (EPO), offer more flexibility in choosing providers, particularly in terms of out-of-network coverage, although EPOs usually have limited options and are closer to the HMO model. Indemnity plans tend to provide a wider range of provider choice without the need for referrals, allowing services both in and outside of networks, but they typically require the member to manage their own