Emphasizes Primary care physician care.

Overview

With a Health Maintenance Organization (HMO) plan, you may choose a primary care physician (PCP) from Humana's network to coordinate all of your care.

There are two types of HMO plans - Traditional HMO and Open Access HMO.

An HMO plan is a good choice if you are willing to use certain providers in exchange for lower out-of-pocket costs.

How it works

Traditional HMO

You select a personal doctor, called a PCP, who tends to the majority of your health needs and refers you to other in-network providers if necessary. See your specific plan materials for any referral requirements. The plan pays benefits only when you use doctors and hospitals in the plan's network.

Open Access HMO

You are not required to select a PCP and or receive referrals. You are free to see any physician as long as they are in the HMO network. See your specific plan materials for any referral requirements. The plan pays benefits only when you use doctors and hospitals in the plan's network.

Plan tools

  • MyHumana tools
  • MyHumana mobile
  • Printable Humana ID card
  • Preauthorization and Notification Lists

How It Works

With an HMO, you're responsible for copayments - fixed fees you pay when you see a doctor, have a prescription filled, or are admitted to the hospital.

Here's how it works:

Traditional HMO
  • Select a primary care physician (PCP) - You select a PCP who tends to the majority of your health needs and refers you to other in-network providers, if necessary. See your specific plan materials for any referral requirements.
  • Build a relationship with your PCP - You can seek guidance from your PCP when you need specialty care. Referrals to specialists may be required. A PCP is usually a general, family, or internal medicine doctor (internist), or a pediatrician.
Open Access HMO
  • You may visit any provider - PCP or Specialist - as long as they are in the HMO network.
  • Take advantage of in-network savings - An HMO pays benefits only when you use doctors and hospitals in the plan's network. For covered services at in-network providers, you pay a copayment and the plan pays the rest.
  • Use out-of-network providers wisely - Coverage for services from out-of-network providers is only provided for emergencies or when Humana has given prior authorization.

Plan Tools

Here are some Humana tools that may be useful to members who have a HMO plan.

MyHumana tools

Visit your secure Website on Humana.com to:

  • Look up what your plan covers
  • Find out about referral and preauthorization requirements
  • Keep track of your claims and healthcare spending
  • Order a replacement ID card

To access these tools and more, Log in to MyHumana. If you haven't signed up for your secure Website yet, Register for MyHumana today.

MyHumana Mobile

Humana's mobile resources are designed to support the on-the-go needs of consumers and empower healthcare decisions at the point of service. Resources featured in MyHumana Mobile include: an urgent care finder, a spending account balance viewer, and ID card details. Use your existing MyHumana login to access the resources on your mobile device's browser.

Learn more about MyHumana Mobile

Printable Humana ID card

To get printable proof of your Humana coverage, simply fill out the online form in our Humana ID Card Viewer

Humana Commercial Preauthorization and Notification Lists

These dated documents provide a complete list of services that require preauthorization or prior authorization. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.

January 22, 2011, Commercial Preauthorization and Notification List
(265 KB) Download PDF
English
January 24, 2010, Commercial Preauthorization and Notification List
(97 KB) Download PDF
English
July 10, 2009, Commercial Preauthorization and Notification List
(92 KB) Download PDF
English

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