Explore Group Plan Types

​​HMO stands for Health Maintenance Organization. An HMO gives you access to certain doctors and hospitals, called a “network.”   

​An HMO is designed to keep costs low and predictable while providing personalized care. With one doctor to arrange your care, an HMO plan is simple and easy to use.

​Quick snapshot

• ​Monthly premiums, copays and deductibles are often lower than other types of plans.
• ​You’ll have access to certain doctors and hospitals within a network. This helps control how much you pay for health care. 
• ​You’ll see a primary care provider (PCP) for routine exams, physicals, colds and flu.
• ​Your PCP will refer you to a specialist for more serious illnesses.

​Six key facts you should know about HMO plans

1. ​When you first sign up for an HMO health plan, you choose or are assigned a PCP. 
2. ​Family members covered by your HMO group plan can pick their PCP.
3. ​In most cases, your HMO plan won't cover your fees from a provider not in your network.
4. ​You don't have to stay in-network or get a referral for emergency medical care.
5. ​If you need to visit a specialist, behavioral health care provider or hospital for non-emergency services, your PCP will refer you to one. 

​Make sure a referred provider, hospital, lab or health care facility is in your plan network.​

PPO stands for Preferred Provider Organization. A PPO gives you flexibility to choose the doctors, hospitals and other providers.

Although your out-of-pocket costs may be more (depending on your group plan), PPO plans let you choose where you go for care.

Quick snapshot

• PPOs often have higher monthly premiums. Also, copays, coinsurance and deductibles may be higher. 
• You don’t need a referral from a primary care provider (PCP) to see a specialist or behavioral health care provider.
• You don’t need to rely only on providers in your plan's network.
• You don’t need a referral to visit a hospital.

Four key facts you should know about PPO plans 

1. You may still need to get prior authorization from BCBSMT before getting certain tests or services.
2. When you get care from a provider or hospital in the network, your costs tend to be lower.  
3. You can get care outside your plan's network, but you will pay more for your out-of-pocket costs.

If family members are on your group PPO plan, they have the same flexibility to choose health care providers. 

You may not be aware of this type of plan. CDHP stands for Consumer Directed Health Plans. This plan is a different way to take charge of your health care costs.

A CDHP gives you coverage like other health plans but adds a tax-advantaged savings account. These savings can be used for your out-of-pocket qualified medical costs.

Quick snapshot

• A CDHP lets you open a Health Savings Account (HSA) for qualified medical expenses. 
• You can fund your HSA yourself. Your employer may also choose to contribute.
• You may have access to a Health Care Account (HCA) funded by your employer for qualified medical expenses.
• You have access to a provider network like other health plans.
• CDHP plans have a higher deductible than many other plans. 

Four key facts you should know about CDHP plans

1. Your HSA pre-tax dollars can pay for a wide range of qualified health care costs. Dental and vision costs also apply.
2. HSA funds roll over every year. Your funds are yours to keep if you change employers.
3. There is a maximum amount you or your employer can contribute to an HSA per year. This amount is set by the IRS. 
4. HCA accounts funded by your employer have certain use rules. Check with your benefits team.