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Active Members Information: HMO
Summary
- The Custom HMO offers a limited network of providers and facilities
- Custom HMOs cover medical services as set forth in the PEBTF Plan Document
- Treatment for medical services must be coordinated by a Primary Care Physician (PCP)
- $5 copayment for PCP office visits (for general practitioners, family practitioners, internists and pediatricians)
- $10 copayment for specialist office visit
- $50 copayment for urgent care visit
- $150 copayment for emergency room visit (waived if the visit leads to an inpatient admission to the hospital)
For more information, refer to your Summary Plan Description or contact PEBTF.
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