Retired Members Info - HMO
Summary
- HMOs cover medical services designated by the Retired Employees Health Program (REHP).
- Treatment for medical services must be coordinated by a Primary Care Physician (PCP).
- $15 copayment for office visits during regular hours; $20 copayment for office visits after hours (UPMC HMO copayments differ - $15 PCP, $25 Specialist).
- $25 copayment for emergency room visit (waived if admitted to hospital)
- HMO members are eligible for payment consideration of certain out-of-pocket medical expenses under the PEBTFs Medical Reimbursement Plan.
A Uniform Plan of Benefits
All HMOs are required to offer coverage for certain benefits specified by the REHP. 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 REHP Benefits Handbook or contact PEBTF.
