Active Member Info: HMO
Summary
- HMOs cover medical services designated in the PEBTF Plan Document.
- Treatment for medical services must be coordinated by a Primary Care Physician (PCP).
- $15 copayment for PCP office visits during regular hours; $20 copayment for office visits after hours.
- $25 copayment for specialist office visits.
- $50 copayment for emergency room visit (waived if admitted to hospital)
A Uniform Plan of Benefits
All HMOs are required to offer coverage for certain benefits specified in the PEBTF Plan Document. These benefits are identical regardless of the HMO provider or region of the Commonwealth.
HMOs may also provide wellness benefits in addition to medical benefits. Wellness benefits include programs such as smoking cessation, weight loss counseling, and fitness club membership discounts. Wellness benefits vary according to your HMO provider.
For more information, refer to your Summary Plan Description or contact PEBTF.
