General Description

YourCorp offers one or more HMO options depending on geographic location.

HMO Overview

Eligibility

YourCorp employees on U.S. payroll who are Regular Full-time or Regular Part-time employees and live in the HMO Service Area. Foreign Service Employees who do not reside in the U.S. are not eligible for an HMO.

Eligibility

Coverage for Relatives

Coverage is available for your spouse and unmarried Children under the Limiting Age or Disabled. Depending on the HMO, coverage may or may not be available for your domestic partner and his/her children.

Eligible Dependents

Which HMOs do not offer domestic partner coverage?

Coverage Begins

Same as for the Medical Plan.

Medical Plan Info at a Glance

Benefit Amounts

Coverage varies by HMO.

How do I...

• Enroll or Change Coverage?

Same as the Medical Plan. However, coverage may or may not be available for your domestic partner and his/her children, depending on the HMO.

Enrollment Procedure

Changing Coverage

Changing Between HMO to Medical Plan

• Add a Dependent?

Same as the Medical Plan. However, coverage may or may not be available for your domestic partner and his/her children, depending on the HMO.

If you want to enroll a domestic partner and you are currently enrolled in an HMO that does not accept domestic partners then you have the option to enroll in the YourCorp Medical Plan. Selecting another HMO that does offer coverage for a domestic partner is not an option.

• Drop a Dependent or Drop Coverage?

Same as the Medical Plan.

• Find an HMO?

If you are considering enrolling in an HMO then you must first verify if you live in the HMO's service area. You can find a description of HMO service areas in the Open Enrollment Guide's HMO Comparison Charts (also available on the web) or call the HMO directly to find out if you are in the service area.

Finding HMO Locations

• File a Claim?

In general, you do not have to file a claim directly with your HMO. Your service provider files any necessary claim and you pay only a co-payment at the time of service.

Emergency Outside Service Area

• Get ID Cards (I haven't received my cards)?

If you enroll in an HMO, you will receive an ID card directly from them. Call the HMO if you do not receive it.

ID Cards

• Appeal a Claim?

Contact your HMO's Member Services to appeal a claim. If you do not agree on the course of treatment, you must pursue the matter through your HMO's appeal process.

If you experience problems in accessing the HMO appeal process, contact the Employee Services Organization.

• Convert Coverage?

In general, coverage may not be converted. COBRA may be available when YourCorp-sponsored coverage ends. However, you may want to check with your HMO since some of them may offer opportunities to convert to private policies.

COBRA Info at a Glance

Costs

YourCorp pays the costs for regular full-time employees. For dependents, you and YourCorp share the cost of coverage.

Approvals

For specific information on pre-certification requirements you must contact your HMO directly.

For additional information:

Contact the Health Program Order Line or contact your HMO directly.

Health Program Order Line