HMO medical plans

What you need to know

In a health maintenance organization (HMO), you and each covered dependent must choose a primary care physician (PCP) within the HMO network. The PCP coordinates all your care with providers within the HMO network.

How an HMO plan works

Pay nothing for preventive care in the HMO network. That includes services like screenings, immunizations, and exams.

You pay only copays when you get care. And there’s no coinsurance to pay, either.

Care outside the HMO network isn’t covered. Unless it’s an emergency situation.

Copays count toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, the plan pays 100% of covered services for the rest of the year.

Pharmacy benefits are provided by the HMO. You pay a copay for generic, brand, and non-brand prescriptions at in-network pharmacies. But prescriptions filled at an out-of-network pharmacy aren’t covered by the plan.

Certain medications cost nothing for Kaiser HMO members. Prescriptions for medications to treat diabetes, high blood pressure, and high cholesterol are provided at no cost to Kaiser HMO members when they are filled by in-network pharmacies.

HMO plans at a glance

You can enroll in an HMO if you live in one of these states:

California: Kaiser HMO
Utah: SelectHealth HMO

Find out more about what these plans have to offer.

Kaiser HMO (CA)

SelectHealth HMO (UT)

Provider contact information


Health Net HMO (AZ) - Discontinued as of 2019
Plan/Group Number

Important information for former Health Net HMO members

If you were previously a member with Health Net HMO in Arizona and you enrolled in a UnitedHealthcare (UHC) medical plan for 2019, your coverage begins January 1. As a new UHC member, there are a few things you should know about your coverage.

Top 5 things to know

  1. The $300 Deductible plan and the CDHP both provide free in-network preventive care for services like screenings, immunizations, and exams, just like the Health Net HMO.
  2. The way you pay for care and the amount the insurance plan covers are different under the UHC plans, so it’s important to understand how the plans work. Learn more about your new medical plan options:
  3. Your Health Net HMO doctor most likely participates in the UHC network. Find out now.
  4. If you enrolled in the $300 Deductible plan, you’ll receive a special one-time only Health Reimbursement Account (HRA) with HealthEquity, available only for 2019. If you enrolled in the CDHP, you can participate in a Health Savings Account (HSA) through HealthEquity. Find out more about how you can save with the HRA and HSA.
  5. Both plans include prescription drug coverage through CVS/caremark, which means in 2019 you'll use your UHC ID card for medical care and your CVS/caremark ID card for prescriptions.

Don’t see your doctor in the UHC network? While nearly all, 98%, of doctors that participate in the Health Net HMO network are part of the UHC network, you can submit a nomination for yours if they are not. Email your nomination to

HSA vs. HRA vs. Health Care FSA: What’s the difference?

Which medical plan does it pair with?

Who administers it?

Who contributes money to it (and how much)?

How much can you contribute in 2019?

What can I use it for?

Do I pay taxes on my contributions?

Do I have to use the funds each year?

We understand you may have questions as we go through this transition. Review the FAQ and Resources links below. If you still have questions, contact PayPal Benefits at and PayPal’s Benefits team will assist you.

Provider contact information


Health Net HMO (AZ) - Discontinued as of 2019
Plan/Group Number

If you have any questions, please contact