Regional Managed Care Plans: HMOs/EPOs
Managed Care Plans including Health Maintenance Organizations (HMOs), and Exclusive Provider Organizations (EPOs) are offered in different geographic regions across the country. You may enroll in a managed care organization if you live within the geographic area in which it is offered. Please note: if enrollment in a managed care plan falls below ten employees, the managed care plan may not be offered going forward.
An important feature of a managed care plan is the Primary Care Physician (PCP). You must choose a PCP, who will then coordinate your care with other providers in the managed care plan. Typically, you need your PCP's authorization before you can see another medical provider.
Here are descriptions of the benefit coverage for each managed care organization. 2024 editions not yet shown below are forthcoming shortly.
- Aetna EPO in CA, GA, NJ, NY, DC (including NY CBU in NJ and NY) Summary of Benefits and Coverage (SBC), Summary of Benefits and Coverage Supplement and the 2024 Summary of Benefits. Once you are enrolled in the Aetna EPO, for your Summary of Coverage/Schedule of Benefits and your booklet with the details of your healthcare benefits, your share of the costs and which services are covered, log into your member website, Aetna Navigator® on www.aetna.com and select “Coverage & Benefits.”
- Emblem Health - HIP HMO in NY (including NY CBU) 2024 Summary of Benefits and Coverage (SBC) and Summary of Benefits
- Kaiser Northern CA HMO - 2024 Summary of Benefits and Coverage (SBC) and 2024 Summary of Benefits and Disclosure
- Kaiser Southern CA HMO - 2024 Summary of Benefits and Coverage (SBC) and 2024 Summary of Benefits and Disclosure